Diverticulosis: Causes and Epidemiology

15 Questions

In Western countries, which part of the colon is most commonly affected by diverticulosis?

Sigmoid colon

What is the primary role of CT-guided percutaneous drainage in diverticulitis?

To drain abdominal abscesses

What is the diagnostic procedure of choice for acute diverticulitis?

Computed Tomography

When is hospitalization required for diverticulitis?

For elderly or immunosuppressed patients

What is the primary goal of outpatient management for mild diverticulitis?

To manage symptoms with a clear liquid diet and antibiotics

What is the typical organism involved in diverticulitis?

All of the above

What is the primary indication for surgical consultation in diverticulitis?

Failure to improve with conservative medical therapy

What is the role of endoscopy in suspected acute diverticulitis?

To avoid, due to risk of perforation

What is the significance of right-sided diverticulosis in Asian countries?

It is more common

What is the primary goal of colonoscopy in diverticulitis?

To exclude competing diagnoses, particularly neoplasia

What is the prevalence of diverticulosis in those younger than 40 years?

< 10%

Which of the following is a risk factor for diverticulosis?

Dietary meat intake

In which region is diverticulosis extraordinarily rare?

Rural Africa and Asia

What is the prevalence of diverticulosis in patients 80 years or older?

50% to 66%

Which of the following is a characteristic of diverticulosis?

Equally common in men and women

Study Notes

Diverticulosis

Diverticulosis occurs when small, bulging pouches (diverticula) develop in the digestive tract.

Epidemiology

Overall prevalence: 12% to 49%
Increases with age:
- < 10% in those younger than 40 years
- > 50% to 66% of patients 80 years
As common in men and women
Men: higher incidence of diverticular bleeding
Women: more episodes of obstruction or stricture
Disease of Western civilization, extraordinarily rare in rural Africa and Asia
Highest prevalence rates: United States, Europe, and Australia
Increases with urbanization

Risk Factors

Increasing age
Dietary meat intake
Living in Western countries (e.g., United States, Western Europe, Australia)
Connective tissue diseases
Decreased risk:
- High dietary fiber intake
- Living in predominantly rural Asian or African countries (e.g., Kenya, Jordan, Thailand)

Factors That Influence the Risk for Diverticulosis

Location:
- In Western countries: left colon (90% sigmoid, 15% right-sided)
- In Asian countries: right-sided

Spectrum of Diverticulosis

Uncomplicated diverticulosis:
- Asymptomatic diverticulosis
- Symptomatic uncomplicated diverticular disease (SUDD)
Complicated diverticulosis:
- Diverticulitis:
  - Uncomplicated diverticulitis: localized phlegmon
  - Complicated diverticulitis: abscess, free perforation with peritonitis, fistula, or obstruction
- Bleeding

Diagnosis

Plain films: abnormal in 30% to 50%
Contrast enema examinations: only water-soluble contrast enemas (e.g., Gastrografin) should be used
Computed tomography (CT):
- Diagnostic procedure of choice for acute diverticulitis
- CT criteria for diverticulitis:
  - Presence of diverticula
  - Pericolic infiltration of fatty tissue (fat stranding)
  - Thickening of the colon wall
  - Formation of abscesses
Endoscopy:
- Avoided in suspected acute diverticulitis due to risk of perforation
- Electively performed 1-3 months after acute phase to exclude competing diagnoses, particularly neoplasia

Management

Outpatient management:
- Mild symptoms
- No peritoneal signs
- Ability to take oral fluids
- Supportive home network
- Treatment with clear liquid diet and antibiotics
Hospitalization:
- Elderly
- Immunosuppressed
- Severe comorbidities
- High fever / significant leukocytosis
- Bowel rest / intravenous fluid
- Broad-spectrum intravenous antibiotics
Complicated diverticulitis:
- Abscess:
  - Small pericolic abscesses: noninterventional management with broad-spectrum antibiotics and bowel rest
  - Percutaneous catheter drainage: CT-guided percutaneous drainage of abdominal abscesses