Diverticular Disease
What is Diverticular disease?
Diverticular disease is a benign (non cancerous) condition of the the large bowel. It is also known as diverticulosis and consists of small pouches (diverticula) that push out through weak spots in the colonic wall. The incidence of diverticular disease increases with age with females more commonly affected than males.
Diverticulitis
Most people with diverticular disease have no symptoms and it is diagnosed ‘incidentally’ with a colonoscopy or on a CT scan. The diverticula, when inflamed is called diverticulitis. Diverticulitis most often causes lower abdominal pain, fever and a change in bowel habit (constipation or occasionally diarrhoea). The diagnosis of diverticulitis is made with a CT scan. A mild attack of diverticulitis can be treated as an outpatient but admission to hospital is at times required, with or without the use of antibiotics pending patient’s condition. Most diverticulitis that are not considered severe can be managed without surgery.
Severe cases of diverticulitis can result in peritonitis (that often requires emergency surgery), an abscess (that usually requires drainage) or a fistula, which is an abnormal communication between the bowel and another structure e.g. bladder (that often warrants surgical management).
Colonoscopy is usually recommended at 6-8 weeks after the diverticulitis episode to exclude cancer.
Bleeding
Occasionally a diverticula can bleed. These bleeds tend to be large in volume, requiring hospitalisation for monitoring +/- intervention. Fortunately, most bleed would stop on their own accord. Blood products are given if required. If the bleeding doesn’t stop on its own, either a colonoscopy, angiography with embolisation (x-ray of the vessels with a ‘plug’ in the bleeding vessel) may be required. Surgery is often the last resort.
Indications for surgery
Perforated diverticulitis causing pus or stool to leak into abdominal cavity, resulting in peritonitis
Fistula formation ie abnormal connection between colon and other neighbouring organs or structures (e.g. vagina, retroperitoneum or bladder)
Obstruction secondary to diverticular stricture from recurrent diverticulitis
Abscess that cannot be effectively drained
Severe cases that do not respond to maximum medical treatment which includes hospitalisation and intravenous antibiotics
Patients with immune system problems (e.g. related to an organ transplant or chemotherapy)
Recurrent episodes of diverticulitis requiring multiple hospital admission or affecting quality of life - this is usually done electively.
Who should be doing my surgery
A consultation with your GP and subsequent referral to a colorectal surgeon will ensure that your symptoms and the need for surgery are appropriately assessed
It is very important that your surgeon is technically skilled in managing these often complex surgeries. Members of CSSANZ have these skills as they have gone through extensive training.
Prevention
While it appears difficult to prevent diverticular disease forming, a high fibre diet is recommended to decrease the risk of another attack for people that have experienced diverticulitis.