Diverticular Disease
Diverticular disease is also known as diverticulosis. This is a condition of the gastrointestinal tract in which the stomach or intestine wall bulges out and forms a pocket.

What is Diverticular Disease?

Diverticular disease is also known as diverticulosis. This is a condition of the gastrointestinal tract in which the stomach or intestine wall bulges out and forms a pocket. Each individual pocket is known as a diverticulum (plural diverticuli).

Diverticular disease of the colon refers to multiple diverticuli in the colon. It develops because of a weakness in the muscle wall of the colon, allowing the inner lining (mucosa) to bulge out between the gaps in the muscle wall.

The word “disease” is actually misleading because it implies that there is something wrong with the colon. Diverticulosis is actually quite common in people above the age of 40 years. Only a small number of those with diverticulosis will ever have symptoms from it in their lifetime. An even smaller number would require surgery for its treatment.

Diverticular disease

Diverticular disease is a term that is better used to describe the situation in which the diverticuli causes problems, whereas diverticulosis is the condition in which the diverticuli is present but not causing any problems. Diverticular disease can manifest either as an infection or bleeding.

Diverticulitis

Inflammation or infection at the area of the diverticuli is called diverticulitis. This may cause fever and pain over the area of the inflammation. It could also be associated with loose stools or diarrhea. In severe cases, the infection can cause perforation and abscess that requires hospitalization and even surgery. There are occasions where the perforation from the colon extends into the surrounding organs such as bladder, resulting in an abnormal communication or fistula between the colon and bladder and the passage of faeces out in the urine.

In some cases, the repeated infection results in scarring and narrowing of the colon, causing a change in bowel habits, and very rarely, blockage of the colon.

Bleeding

This pattern of disease occurs more commonly in Asian as compared to the Western population. Blood vessels at the edge of the diverticulum breaks and bleeds. The patient has repeated episode of passing out stale blood, which may be only dark red blood and blood clots, or associated with small amount of stools. This differs from bleeding from more common conditions such as haemorrhoids in which the blood is fresh and bright red.

What is the cause of diverticular disease?

It is postulated that inadequate fibre in the diet creates a high pressure in the colon. This pressure then causes pockets or diverticula of the colon. However, once the diverticuli have formed, taking a high fibre diet does not reverse the condition.

How is diverticular disease treated?

In most people, having diverticulosis without any symptoms does not require any treatment.

Mild diverticulitis is treated with antibiotics in an outpatient setting. More severe diverticulitis may require hospitalization, bowel rest, intravenous drip and antibiotics.

For the most severe type of diverticulitis where there is a perforation in the colon or an abscess, emergency surgery to remove that segment of the colon may be required. Surgery may also be necessary for people with recurrent episodes of diverticulitis or other complications that occur after an attack.

For those with bleeding from diverticular disease, treatment usually comprises of hospitalization, bowel rest with an intravenous drip and blood transfusion if there is substantial blood loss.

In most patients, the bleeding stops on its own without further intervention. In some, the bleeding persists and requires a procedure under x-ray guidance to inject some material into the blood vessel to block it off and stop the bleeding. In other cases, persistent or recurrent bleeding requires surgery.

Surgery for Diverticular Disease

Diverticular disease affects only the colon and not the rectum. When surgery is required, the segment of the colon affected by diverticular disease is removed while sparing the rectum. The colon is then joined back and the continuity of the intestines is restored. It is very unusual that a stoma (an opening in the abdominal wall for faeces to pass out) is required.

Traditionally, the surgery to remove the colon is done through a long incision in the centre of the abdomen. However, with recent advances in techniques and technology, most surgery on the colon can now be done by minimally invasive surgery. This can be either standard laparoscopic surgery or the more advanced robotic surgery. Minimally invasive surgery has the benefit of being less painful and lead to faster recovery.