Diverticulosis is a term denoting the presence of several sac-like structures that stem from the mucosa and submucosa of the intestinal wall, and it's almost exclusive location in the large intestine explains why the term "colonic diverticulosis" is used [1] [2] [3] [4] [5]. In recent years, it has become evident that colonic diverticulosis is quite commonly found in the senile population primarily living in the Western world, with the single most important risk factor being a low-fiber diet [2] [3] [6]. Furthermore, obesity and certain drug groups (opioids, corticosteroids, and non-steroidal anti-inflammatory drugs, or NSAIDs) have also been associated with colonic diverticulosis [2]. The clinical presentation is asymptomatic in 70-80% of patients, which is supported by the fact that they are one of the most frequent incidental findings on colonoscopy [2] [4] [5]. Symptoms may appear in the presence of an infection (termed diverticulitis), while diverticular disease refers to the development of typical lower gastrointestinal tract symptoms - abdominal pain (often on the left side), cramping, fever, and bloating [3] [4] [5] [6]. Altered bowel habits (more commonly constipation than diarrhea) and a sense of fullness in the lower left quadrant are also reported, whereas painless rectal bleeding (abrupt and sometimes voluminous) is a highly indicative sign of an ongoing disease in the lower gastrointestinal tract [5] [6]. Both acute and chronic course of illness has been reported [5].

• Sepsis

  One patient who had had an emergency procedure died of sepsis and ketoacidosis in the post-operative period. [ncbi.nlm.nih.gov]

  Drainage alone is insufficient to control sepsis. If faecal drainage continues, surgical intervention is usually required. [mja.com.au]

  Progression of sepsis can result in perforation, which is often contained locally in the form of an abscess. [surgwiki.com]

  Also, patients with free air but without systemic sepsis or peritonitis may have a sealed perforation and can be selectively managed nonoperatively. [lacolon.com]

  COMPLICATIONS The complications of diverticular disease include sepsis, fistula (usually as a result of healed sepsis), bleeding, obstruction, and intractable painful disturbance of bowel function. [ots1.narod.ru]

• Chills

  As you’ve probably noticed, fatigue, chills and nausea can indicate the presence of numerous different conditions, including the flu. [marcianolegal.com]

  You may also have fever, nausea, vomiting, chills, cramping, and constipation. In serious cases, diverticulitis can lead to bleeding, tears, or blockages. Your doctor will do a physical exam and imaging tests to diagnose it. [medlineplus.gov]

  Chills. Cramps in the lower abdomen. Constipation or diarrhea (less common). Rectal bleeding. Get useful, helpful and relevant health + wellness information enews Cleveland Clinic is a non-profit academic medical center. [my.clevelandclinic.org]

  There may be systemic signs of infection, such as fever, general fatigue, chills, sweating, headache, loss of appetite. Cause [ edit ] Commonly caused by bacterial infection, as in the case of cellulitis or diverticulitis. [en.wikipedia.org]

• Weight Loss

  There was no history of chronic constipation, fever, diarrhea or weight loss. The patient's prior history was significant for spontaneous colonic perforation that required colostomy and resection of sigmoid colon (6cm) two years prior. [journals.lww.com]

  Typical symptoms are abdominal pain, weight loss, diarrhea. There may also be rectal bleeding that can lead to anemia. Special X-rays and tests are needed to differentiate Crohn’s from other diseases with similar symptoms. [dmu.edu]

  In many cases, it is asymptomatic, even though postprandial abdominal pain or, during exercise, nauseas, vomiting, and weight loss could be found. [websurg.com]

  He had experienced no weight loss and had regular bowel habit. Over the next four months the patient developed worsening discomfort, alteration in bowel habit described as increased frequency of loose motions, and weight loss. [casesjournal.biomedcentral.com]

• Rigor

  Over an 11-year period, 23 patients (1%) developed rigorously-confirmed diverticulitis for an incidence rate of 1.5 per 1000 patient-years. [hindawi.com]

• Abdominal Pain

  These regular rhythms are associated significantly with reporting of abdominal pain. [ncbi.nlm.nih.gov]

  The majority of patients are asymptomatic, whereas inflammatory changes and infections of diverticula can lead to symptoms such as fever, abdominal pain, bloating, and even lower gastrointestinal bleeding. [symptoma.com]

  Similarly, no serological or mucosal inflammation was associated with symptomatic cases of diarrhea or abdominal pain vs asymptomatic controls. [researchers.mq.edu.au]

  Acute diverticulitis • ‘left-sided appendicitis’ • Change in bowel habit eg.constipation • Bloody or purulent stool • pain- colicky abdominal pain • Tenderness- suprapubic, shifting to left iliac fossa. • Local signs of peritonitis • Mass- tender, firm [slideshare.net]

• Abdominal Tenderness

  Abdominal tenderness, fever, nausea, and constipation or diarrhea may also be present. How is colonic diverticulosis diagnosed? Most patients suffering from diverticulosis have no symptoms. [giforkids.com]

  Abdominal tenderness. Constipation or, less commonly, diarrhea. When to see a doctor Get medical attention anytime you have constant, unexplained abdominal pain, particularly if you also have fever and constipation or diarrhea. [mayoclinic.org]

  The most common clinical presentation is abdominal pain, but GCD can be asymptomatic. An abdominal mass is the most usual physical sign, but fever and abdominal tenderness can also be present. [jbsr.be]

• Flatulence

  Introduce fibre gradually to avoid unpleasant symptoms such as flatulence. Consider using a fibre supplement (such as psyllium). Drink plenty of fluids to ensure your stools are soft, moist and easy to pass. [betterhealth.vic.gov.au]

  – They tend to occur in rows between the strips of longitudinal muscle, some-times partly covered by appendices epiploicae 21. stages 22. diverticulosis • 90% • Asymptomatic • Vague complain- – Discomfort – Fullness – Bloating – flatulance • x ray- [slideshare.net]

  These bacteria also account for the production of gases inside our intestine (this gas is released as flatulence when removed through the anus). [wikidoc.org]

  […] consume a high-roughage diet in contrast with the refined, lower-roughage diet of Western populations.[6] Signs and symptoms[edit] Diverticulosis, 70 y.o, sigmoid colon Some people with diverticulosis complain of symptoms such as cramping, bloating, flatulence [en.wikipedia.org]

• Abdominal Mass

  We present the case of a 84-year-old woman presenting with a painless abdominal mass and constipation. A 30 x 10 cm gas-filled cyst was discovered on abdominal X-ray and CT examination. [ncbi.nlm.nih.gov]

  A palpable abdominal mass in a patient with diverticulitis is almost invariably a paracolic inflammatory mass related to acute diverticulitis. [jmedicalcasereports.com]

  GIST's are abdominal masses that are rarely found in the colon and are histologically composed of spindle-cells with epithelioid mesenchymal features. [ispub.com]

  The most common clinical presentation is abdominal pain, but GCD can be asymptomatic. An abdominal mass is the most usual physical sign, but fever and abdominal tenderness can also be present. [jbsr.be]

• Hematochezia

  Images in Clinical Medicine George Triadafilopoulos, M.D. 4 Citing Articles Figure 1 A 42-year-old man with a history of mild, intermittent pain on the lower left side of the abdomen presented with an episode of painless hematochezia. [nejm.org]

  Diverticular bleeding manifests as painless hematochezia. Because the bleeding vessel is an arteriole, the amount of blood loss is usually moderate to severe. [msdmanuals.com]

  […] unclear radiological findings (e.g., to determine malignant/ benign nature of stenoses, exclude neoplasia for hypertrophied folds or stool particles) ► preoperative to determine which colonic segments are affected by diverticula Treatment indications ► hematochezia [rrnursingschool.biz]

• Hypotension

  Physical Exam Vital signs may reveal signs of systemic involvement, including: fever tachycardia hypotension Abdominal exam should be performed, including digital rectal exam. [sharinginhealth.com]

  […] bleeding Frequency: occurs in around 5% of cases of patients with diverticulosis Caused by erosions around the edge of diverticula Clinical findings Painless hematochezia Severe or ongoing bleeding: significant drop in hemoglobin, hemodynamic instability (hypotension [amboss.com]

  Fever and tachycardia are present in most patients; hypotension and shock are unusual. Anorexia, nausea and vomiting may occur. Examination usually reveals localised tenderness and, occasionally, a palpable mass. [patient.info]

• Ulcer

  In particularly, in literature, there are few studies about the prevalence of colonic diverticulosis in patients affected by ulcerative colitis (UC). [ncbi.nlm.nih.gov]

  Colorectal carcinoma would grossly exhibit a partially ulcerative, fungating mass protruding into the bowel lumen. [ispub.com]

  Crohn's disease and ulcerative colitis are examples of inflammatory bowel disease. While Crohn's can affect the entire gastrointestinal tract, ulcerative colitis is limited to the large intestine. [wikidoc.org]

  On the contrary, ulcerative colitis (UC) affects younger people and inflammation involves the rectosigmoid area in the vast majority of patients. [ecco-ibd.eu]

  Dig Dis. 25(2):151-9, 2007 Rispo A et al: Lower prevalence of diverticulosis in patients with ulcerative colitis. [app.statdx.com]

The diagnosis of colonic diverticulosis must be considered in old-age patients who present with lower gastrointestinal tract related symptoms. A properly obtained history is the first step, during which assessment of risk factors, such as dietary intake of fiber and use of various drugs, as well as the course and progression of symptoms, should be noted. Physical examination can reveal tenderness in the lower left quadrant in symptomatic patients, while palpation of the sigmoid colon in this area is also seen in colonic diverticulosis [5]. To solidify the diagnosis, imaging studies need to be performed. Barium enema was previously considered as the gold standard in the evaluation of colonic diverticulosis, but in the presence of an intestinal perforation, the contrast material may reach extraintestinal tissue and cause complications [5]. For this reason, computed tomography (CT) has emerged as the optimal procedure [1] [3] [5]. The presence of air-filled pouches arising from the colonic wall, primarily located in the sigmoid colon, are hallmarks of colonic diverticulosis [1]. In addition, ultrasonography has been described as a beneficial method in certain studies, describing diverticula as hypoechoic or anechoic structures protruding from the colonic wall that shows signs of hypertrophy [5]. Finally, colonoscopy should be employed as a definite method if inconclusive findings are obtained from CT or ultrasonography, although CT colonography is becoming a suitable replacement, being less invasive but equally effective than colonoscopy [5].

• Colitis

  GOALS/BACKGROUND: Reports of segmental colitis with diverticula regard this entity as a local disease. [ncbi.nlm.nih.gov]

  A segmental colitis which shares some endoscopic and histologic features with IBD [Segmental Colitis Associated with Diverticulosis (SCAD)] has also been described in patients with diverticulosis. [ecco-ibd.eu]

  colitis, and ischemic colitis. [msdmanuals.com]

  Diverticular-associated colitis - see below. Bowel obstruction - not common, may mimic malignancy. [3] Diverticular disease-associated colitis Features: [4] Rare. [librepathology.org]

• Leukocytosis

  Fever and leukocytosis generally are present. Other commonly associated symptoms include nausea, vomiting, and constipation or diarrhea. [aafp.org]

  […] diverticulum –huge gas-containing cyst-like structure arising in left iliac fossa Diverticulitis Perforation of diverticulum with pericolic abscess of varying size; not simply inflammation of a tic Clinical Findings Pain and tenderness, mass in LLQ Fever, leukocytosis [learningradiology.com]

  Smoldering diverticulitis Smoldering diverticulitis consists of abdominal pain and a change in bowel habit, without obvious fever or leukocytosis. This condition can persist for 6–12 months. [worldgastroenterology.org]

  Seventy five per cent of initial episodes of diverticulitis are uncomplicated, presenting with the triad of left lower quadrant tenderness, fever and leukocytosis. [lacolon.com]

Conservative Treatment There are no established guidelines for the treatment of RSD, and current recommendations usually refer to the left colon.50,51 The incidence of complicated RSD during the first episode is low, and conservative treatment may be [elsevier.es]

Asymptomatic diverticulosis requires no treatment. When symptoms develop, treatment varies depending on clinical manifestations. [msdmanuals.com]

Treatment is usually reserved for diverticulitis of diverticular hemorrhage. [radiopaedia.org]

Diverticulitis may progress into abscess formation, if treatment is delayed, the diverticuli may perforate and cause life threatening peritonitis. Treatment As diverticuli are closed to blood vessels, inflammation may cause bleeding. [colorectal.com.hk]

Recommendations Fluoroscopic Findings Radiographic Findings CT Findings Ultrasonographic Findings General Features Staging, Grading, & Classification Gross Pathologic & Surgical Features Microscopic Features Presentation Demographics Natural History & Prognosis [app.statdx.com]

Treatment and prognosis The majority of patients remain asymptomatic throughout life and no treatment is required. A high fiber diet may reduce the incidence of diverticula and rate of complications 7. [radiopaedia.org]

Course & Prognosis • 10-20% of patients experience complications, mainly diverticulitis and lower GI bleeding. • Conservative management of diverticular disease is preferred. • Surgery reserved for major complications. • In UK, surgery usually for cases [slideshare.net]

A special care and follow-up may be needed in RTRs with autosomal dominant polycystic kidney disease etiology, smoking history, and coronary artery disease due to higher risk of diverticulosis and subsequent potential diverticulitis. [ncbi.nlm.nih.gov]

No underlying etiology was determined for the colonic perforation. She had been asymptomatic until this hospitalization. [journals.lww.com]

[…] indentations and narrowing of lumen of colon TOP DIFFERENTIAL DIAGNOSES • Giant sigmoid diverticulum Represents chronic, walled-off abscess that communicates with colonic lumen • Diverticulitis Due to perforation of 1 or more diverticula PATHOLOGY • Etiology [radiologykey.com]

World J Gastroenterol. 14(15):2411-3, 2008 Martel J et al: History, incidence, and epidemiology of diverticulosis. [app.statdx.com]

PURPOSES: Colonoscopic evidence of epidemiological trends in diverticulosis and diverticular bleeding is scarce. We evaluated trends in diverticular disease and associated factors over 9 years. [ncbi.nlm.nih.gov]

This review appraises existing evidence on the epidemiology and mechanisms of perforation, highlights areas of further study, and suggests an epidemiological approach towards preventing the condition. [pmj.bmj.com]

Further studies are needed to investigate this association and its putative pathophysiological mechanisms. [ncbi.nlm.nih.gov]

"Etiology and pathophysiology of diverticular disease". Clinics in Colon and Rectal Surgery. 17 (3): 147–53. doi:10.1055/s-2004-832695. PMC 2780060. [en.wikipedia.org]

Case report and overview of pathophysiology, diagnosis and therapeutic options. Acta Chir Belg. 114(3):206-8, 2014 Hirata T et al: Association between colonic polyps and diverticular disease. [app.statdx.com]

RECENT FINDINGS: High-fiber diet does not prevent diverticulosis occurrence, and results about prevention/treatment of diverticular disease and acute diverticulitis are still conflicting.No association was seen between nut, corn or popcorn consumption [ncbi.nlm.nih.gov]

Consuming 20 to 35 g of fiber each day may help prevent the complications of diverticulosis. [livestrong.com]

Diet high in fiber increases stool bulk and prevents constipation, and theoretically may help prevent further diverticular formation or worsening of the diverticular condition. [medical-dictionary.thefreedictionary.com]

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3. Weizman AV, Nguyen GC. Diverticular disease: Epidemiology and management. Can J Gastroenterol. 2011;25(7):385-389.
4. Hobson KG, Roberts PL. Etiology and Pathophysiology of Diverticular Disease. Clin Colon Rectal Surg. 2004;17(3):147-153.
5. Salzman H, Lillie D. Diverticular disease: diagnosis and treatment. Am Fam Physician. 2005;72(7):1229-1334.
6. Boynton W, Floch M. New strategies for the management of diverticular disease: insights for the clinician. Therap Adv Gastroenterol. 2013;6(3):205-213.