Diverticular disease/diverticulosis/diverticulae/diverticulitis

Diverticulae are little outpouches (sacs) that can develop in wall of the colon.  They resemble the ‘blisters’ that one might see on a bicycle inner tube as a result of overinflation.  They are thought to be due to high pressures within the colon, the result of spasms of the colon wall muscle.  A person with more than one diverticulum (most people with diverticulae have several) is said to have ‘diverticulosis’ or ‘diverticular disease’.  Occasionally a diverticulum can pop (perforate), and this leads to the leakage of gas and stool into the abdominal cavity, and the development of inflammation adjacent to the perforation.  Inflammation associated with a diverticulum is called diverticulitis.  Usually the inflammation is mild and heals with the help of antibiotics.  Sometimes, however, the perforation may be larger and more dramatic and the patient may need life-saving surgery to deal with the hole in the bowel.

Given that 50% of individuals in North America over the age of 50 have some diverticulae, the risk of perforation is actually quite low, even though, given the sheer numbers of people with diverticulosis, General and Colorectal Surgeons deal with perforated diverticulitis all the time.  So, diverticulosis is common, diverticulitis is much less common.

Diverticulae occur most commonly in the sigmoid colon, the portion of the colon in the left lower quadrant of the abdomen, and so the pain of diverticulitis is usually felt in the left lower quadrant.  Some people feel that diverticulae are more likely to perforate if the patient eats nuts and seeds, which, theoretically can get caught in the diverticulae and lead to inflammation.  But there is very little good evidence to support this.  Most medical websites suggest that a high fiber diet reduces the chance of developing diverticulae and diverticulitis.  But the data here is also lacking.

© Pezim Clinic, Vancouver, British Columbia, Canada