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Managing Patients with Diverticulosis

Bruce Stewart MB BS, FRACS

While asymptomatic diverticular disease requires no specific treatment, acute diverticulitis should be managed with bowel rest and antibiotics, plus further investigations if symptoms do not resolve within 48 hours. Emergency surgery is sometimes necessary.

• Diverticulosis is a common condition in the Western world, effecting most people over 50 years of age. The vast majority of patients will have no significant clinical sequelae and the diagnosis may only be made incidentally during investigations for other colonic pathology.
• The aetiology is presumed to relate to a refined diet with inadequate fibre intake leading to segmental colonic spasm, with high intraluminal pressure between constricted segments allowing mucosal herniation through the muscular wall of the bowel. The herniation usually occurs along the line of feeding vessels, which represent the site of maximal weakness, and there is usually associated muscle wall hyperthropy due to the heightened muscular activity.
• Diverticulosis can occur anywhere in the large bowel but most commonly affects the sigmoid colon. Most complications occur in the sigmoid colon, even in patients who have widespread colonic involvement.

Clinical assessment

Is the most important determinant of the severity of the case of diverticulitis.