Diverticular Disease

What is diverticular disease?

Diverticulosis is a common benign (non-cancerous) condition that affects around half of all Australians by age 60 and nearly all by age 80. Only a small percentage of patients will develop symptoms. Diverticulae consist of small pockets or out-pouchings of the bowel wall. They usually affect the left colon (sigmoid) but can affect any area of the colon (and rarely the small bowel). Diverticulosis describes the presence of these pockets.

What is the cause of diverticular disease?

Although not precisely known, it is believed that a low fibre diet is a major contributor to the disease. It is thought that the low fibre diet creates higher colon pressure particularly in the sigmoid colon and leads to the formation of diverticulae.

Can diverticular disease be prevented?

It appears difficult to prevent diverticular disease from forming in developed countries. A diet high in fibre or a fibre supplement is generally recommended to decrease the risk of complications.

What is diverticulitis?

Diverticulitis reflects inflammation of the bowel due to a microperforation of a diverticulae. This generally presents with lower abdominal pain and tenderness and a fever. A CT scan is usually required to make the diagnosis. Often, a mild attack can be treated at home but a severe attack may require admission to hospital.

What are the complications of divertilular disease and how is it treated?

The most common complication of diverticular disease is diverticulitis. This usually is treated with IV fluids and antibiotics. Other complications include:

• Perforation. A full thickness hole in the bowel associated with the diverticulae. Unless this is localised, surgery may be required to resect the diseased colon.
• Fistula. Most commonly this involves a communication between the diseased colon and the bladder but can be to other organs such as the uterus/vagina, small bowel or stomach. It typically follows an episode of diverticulitis and will usually require surgery.
• Bleeding. Generally presents with large volume painless bright red bleeding. This will usually stop by itself but will sometimes need intervention.
• Stricture. This is where the bowel has become so narrow that the stool struggles to pass through the area. This also usually requires resection of the diseased bowel.

Who needs surgery?

Surgery is generally only needed for patients with complications from diverticilitis. Recurrent episodes of diverticulitis significantly impacting on quality of life, complications from a severe attack such as perforation, stricture, fistulae or recurrent significant bleeding would all be considered indications for surgery. Often the diseased colon can be resected and joined to the rectum with complete recovery and low recurrence rates. In the emergency setting, a stoma is generally required.

What is a colorectal surgeon?

A colorectal surgeon is an expert in the surgical and non-surgical treatment of colon and rectal conditions. In Australia, a colorectal surgeon has completed general surgical training to be a specialist general surgeon (FRACS). A minimum of 2 years of clinical post-fellowship training is then undertaken in high volume accredited institutions through the Colorectal Surgical Society of Australia and New Zealand (CSSANZ). There is also a research requirement and a written examination on colon and rectal conditions. An equivalent domestic or international experience may qualify a surgeon for CSSANZ accreditation.