Nejm 2007;357:2057

Cause:Diverticulosis, which may be congenital but is usually acquired

Pathophys:(Nejm 1975;293:83) Low-residue diet leads to increased intracolonic pressures causing outpocketings (diverticula); diverticultis caused by micro and macro perforations

Diverticulosis prevalence 5-10% over age 45 yr, 80% over age 85 yr. Right-sided disease more common in Asians

Sx:Left lower quadrant pain usually, though may be anywhere; fever; diarrhea initially often, then constipation

Si:Tenderness, mass in left lower quadrant; fever

Variable; under age 50 yr, 33% recur over 10 yr; higher recurrence in older pts

Perforation; partial obstruction; abscess; fistulas; bleeding from diverticulosis alone, dx by colonoscopy acutely (Nejm 2000;342:78)

r/o right-sided angiodysplasia of the colon, often seen in elderly and associated with aortic stenosis

Lab: Hem:elevated WBC and L shift

Xray:CT scan; ultrasonography; tagged red cell scan or angiography (Nejm 1972;286:450) to localize diverticular bleeding

Rx:

Prevent w high-fiber diet, nuts, popcorn et al actually protect, don’t induce (Jama 2008;300:907); avoid opiates

Antibiotics for acute disease, eg; ciprofloxacin + metronidazole × 7-10 d po, or iv ampicillin + gentamicin + metronidazole

CT-guided percutaneous drainage if abscess >5 cm diameter

Surgical staged colonic resection with temporary colostomy for perforation/abscess, or electively for recurrent attacks