Diverticular disease of colon (large intestine)

Diverticular are small outpouchings of inner lining (mucosa) of colon that protrude through localized weakening of overlying muscle layer.

The presence of colonic diverticular that do not cause any symptoms is termed as diverticulosis. These are usually detected during abdominal investigation for other unrelated conditions.

On the other hand, when there are symptoms that are directly ascribable to swelling (i.e., inflammation) of the diverticular, the medical condition is diverticulitis.

Diverticulosis of colon can affect practically the whole of colon. Diverticulitis however affects mainly the left (sigmoid colon).

The main symptoms of colonic diverticulitis include: lower abdominal pain, fever and constipation.

Sometimes the patient may present with passage of blood in the stools.

Colonic diverticulitis is usually diagnosed with typical features at abdominal CT scan and corroborating blood tests.

The treatment for colonic diverticulitis depends on the severity of disease. The milder form od disease may be treated with bowel rest and pain killers. Patients with localized abscess may be advised image guided drainage and antibiotics while those with free perforation would need emergency surgery.

The options for emergency surgery include laparoscopic lavage and drainage, resection of diseased sigmoid colon, colorectal anastomosis and diverting loop ileostomy. Hartmann’s procedure is no longer a preferred option in view of technical difficulties at subsequent surgery for restoration of continuity.

Yes early elective surgery for these patients provide better quality of life. Patients with history of recurrent colonic diverticulitis elective surgery offers important advantages over emergency surgery such as single stage surgery (Vs two stage surgery in emergency situation) and increased chances of laparoscopic surgery (Vs open surgery in emergency situation).