Skip to main content
SpringerLink
Log in

Benign Colon: Diverticular Disease

  • Reference work entry
The ASCRS Textbook of Colon and Rectal Surgery

Abstract

The term “diverticular disease” of the colon represents a continuum of anatomic and pathophysiologic change within the colon related to the presence of diverticula. These changes most often occur in the sigmoid colon. The continuum can range from the presence of a single diverticulum (a sac or pouch in the wall of an organ) to many diverticula (which may be too numerous to count). It can refer to an asymptomatic state (diverticulosis) or any one of a number of diverse combinations of inflammatory symptoms, changes, and complications (diverticulitis).

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Institutional subscriptions

Notes

  1. 1.

    The practice parameters set forth in this document have been developed from sources believed to be reliable. The American Society of Colon and Rectal Surgeons makes no warranty, guarantee, or representation whatsoever as to the absolute validity or sufficiency of any parameter included in this document, and the Society assumes no responsibility for the use or misuse of the material contained herein.

References

  1. Almy TP, Howell DA. Diverticula of the colon. N Engl J Med 1980;302:324–331.

    Article  CAS  PubMed  Google Scholar 

  2. Rankin FW, Brown PW. Diverticulitis of the colon. Surg Gynecol Obstet 1930;50:836–847.

    Google Scholar 

  3. Heller SN, Hackler LR. Changes in the crude fiber content of the American diet. Am J Clin Nutr 1978;31:1510–1514.

    CAS  PubMed  Google Scholar 

  4. Parks TG. Natural history of diverticular disease of the colon. Clin Gastroenterol 1975;4:53–69.

    CAS  PubMed  Google Scholar 

  5. Colcock BF. Diverticular Disease of the Colon. Philadelphia: WB Saunders; 1971.

    Google Scholar 

  6. Schoetz DJ Jr. Diverticular disease of the colon: a century‐old problem. Dis Colon Rectum 1999;42:703–709.

    Article  PubMed  Google Scholar 

  7. Corman ML. Colon and Rectal Surgery. 5th ed. Philadelphia: Lippincott Williams & Wilkins; 2005.

    Google Scholar 

  8. Somasekar K, Foster ME, Haray PN. The natural history diverticular disease: is there a role for elective colectomy? J R Coll Surg Edinb 2002;47:481–484.

    CAS  PubMed  Google Scholar 

  9. Roberts PL, Veidenheimer MC. Current management of diverticulitis. Adv Surg 1994;27:189–208.

    CAS  PubMed  Google Scholar 

  10. Morris CR, Harvey IM, StebbingsWS, et al. Epidemiology of perforated colonic diverticular disease. Postgrad Med J 2002; 78:654–658.

    Article  CAS  PubMed  Google Scholar 

  11. Painter NS, Truelove SC, ArdranGM, et al. Segmentation and the localization of intraluminal pressures in the human colon, with special reference to the pathogenesis of colonic diverticula. Gastroenterology 1965;49:169–177.

    CAS  PubMed  Google Scholar 

  12. Mann CV. Problems in diverticular disease. Proctology 1979;1:20–25.

    Google Scholar 

  13. Ryan P. Two kinds of diverticular disease. Ann R Coll Surg Engl 1991;73:73–79.

    CAS  PubMed  Google Scholar 

  14. Floch MH, Bina I. The natural history of diverticulitis: fact and theory. J Clin Gastroenterol 2004;38(suppl):S2–S7.

    Article  PubMed  Google Scholar 

  15. Hinchey EJ, Schaal PG, Richards GK. Treatment of perforated diverticular disease of the colon. Adv Surg 1978;12:85–109.

    CAS  PubMed  Google Scholar 

  16. Colecchia A, Sandri L, CapodicasaS, et al. Diverticular disease of the colon: new perspectives in symptom development and treatment. World J Gastroenterol 2003;9:1385–1389.

    PubMed  Google Scholar 

  17. Huizinga JD, Waterfall WE, Stern HS. Abnormal response to cholinergic stimulation in the circular muscle layer of the human colon in diverticular disease. Scand J Gastroenterol 1999;34:683–688.

    Article  CAS  PubMed  Google Scholar 

  18. Maselli MA, Piepoli AL, GuerraV, et al. Colonic smooth muscle responses in patients with diverticular disease of the colon: effect of the NK2 receptor antagonist SR48968. Dig Liver Dis 2004;36:348–354.

    Article  CAS  PubMed  Google Scholar 

  19. Golder M, Burleigh DE, BelaiA, et al. Smooth muscle cholinergic denervation hypersensitivity in diverticular disease. Lancet 2003;361:1945–1951.

    Article  CAS  PubMed  Google Scholar 

  20. Tomita R, Fujisaki S, TanjohK, et al. Role of nitric oxide in the left‐sided colon of patients with diverticular disease. Hepatogastroenterology 2000;47:692–696.

    CAS  PubMed  Google Scholar 

  21. Aldoori WH, Giovannucci EL, Rimm EB, et al. A prospective study of diet and the risk of symptomatic diverticular disease in men. Am J Clin Nutr 1994;60:757–764.

    CAS  PubMed  Google Scholar 

  22. Manousos O, Day NE, Tzonou A, et al. Diet and other factors in the aetiology of diverticulosis: an epidemiological study in Greece. Gut 1985;26:544–549.

    Article  CAS  PubMed  Google Scholar 

  23. Cummings JH, Stephen AM. The role of dietary fibre in the human colon. Can Med Assoc J 1980;123:1109–1114.

    CAS  PubMed  Google Scholar 

  24. Edwards C. Physiology of the colorectal barrier. Adv Drug Deliv Rev 1996;28:173–190.

    Article  Google Scholar 

  25. Anonymous. Dietary fibre: importance of function as well as amount [editorial]. Lancet 1992;340:1133–1134.

    Google Scholar 

  26. Mariadason JM, Catto‐Smith A, Gibson PR. Modulation of distal colonic epithelial barrier function by dietary fibre in normal rats. Gut 1999;44:394–399.

    Article  CAS  PubMed  Google Scholar 

  27. Hirose Y, Sugie S, YoshimiN, et al. Induction of apoptosis in colonic epithelium treated with 2‐amino‐1‐methyl‐6‐phenylimidazo[4,5–b]pyridine (PhIP) and its modulation by a P4501A2 inducer, beta‐naphthoflavone, in male F344 rats. Cancer Lett 1998;123:167–172.

    Article  CAS  PubMed  Google Scholar 

  28. Sesink AL, Termont DS, Kleibeuker JH, et al. Red meat and colon cancer: the cytotoxic and hyperproliferative effects of dietary heme. Cancer Res 1999;59:5704–5709.

    CAS  PubMed  Google Scholar 

  29. McConnell EJ, Tessier DJ, Wolff BG. Population‐based incidence of complicated diverticular disease of the sigmoid colon based on gender and age. Dis Colon Rectum 2003;46: 1110–1114.

    Article  PubMed  Google Scholar 

  30. Hart AR, Kennedy HJ, Stebbings WS, et al. How frequently do large bowel diverticula perforate? An incidence and cross‐sectional study. Eur J Gastroenterol Hepatol 2000;12:661–665.

    Article  CAS  PubMed  Google Scholar 

  31. Schwartz HA. Lower gastrointestinal side effects of nonsteroidal anti‐inflammatory drugs. J Rheumatol 1981;8:952–954.

    CAS  PubMed  Google Scholar 

  32. Day TK. Intestinal perforation associated with osmotic slow release indomethacin capsules. BMJ 1983;287:1671–1672.

    Article  CAS  PubMed  Google Scholar 

  33. Tyau ES, Prystowsky JB, Joehl RJ, et al. Acute diverticulitis. A complicated problem in the immunocompromised patient. Arch Surg 1991;126:855–858.

    CAS  PubMed  Google Scholar 

  34. Painter NS, Truelove SC. The intraluminal pressure patterns in diverticulosis of the colon. Part II. The effect of morphine. Gut 1964;5:207–213.

    Google Scholar 

  35. Papagrigoriadis S, Macey L, Bourantas N, et al. Smoking may be associated with complications in diverticular disease. Br J Surg 1999;86:923–926.

    Article  CAS  PubMed  Google Scholar 

  36. Aldoori WH, Giovannucci EL, Rimm EB, et al. A prospective study of alcohol, smoking, caffeine, and the risk of symptomatic diverticular disease in men. Ann Epidemiol 1995;5:221–228.

    Article  CAS  PubMed  Google Scholar 

  37. Tonnesen H, Engholm G, Moller H. Association between alcoholism and diverticulitis. Br J Surg 1999;86:1067–1068.

    Article  CAS  PubMed  Google Scholar 

  38. Morganstern L, Weiner R, Michel SL. “Malignant” diverticulitis. A clinical entity. Arch Surg 1979;114:1112–1126.

    Google Scholar 

  39. Killingback M. Surgical treatment of diverticulitis. In: Fazio VW, Church JM, Delaney CP, eds. Current Therapy in Colon and Rectal Surgery. 2nd ed. Philadelphia: Elsevier/Mosby; 2005:284–295.

    Google Scholar 

  40. Breen RE, Corman ML, Robertson WG, et al. Are we really operating on diverticulitis? Dis Colon Rectum 1986;29:174.

    Article  CAS  PubMed  Google Scholar 

  41. Thorn M, Graf W, Stefansson T, Pahlman L. Clinical and functional results after elective colonic resection in 75 consecutive patients with diverticular disease. Am J Surg 2002;183:7–11.

    Article  PubMed  Google Scholar 

  42. Horgan AF, McConnell EJ, Wolff BG, et al. Atypical diverticular disease: surgical results. Dis Colon Rectum 2001;44:1315–1318.

    Article  CAS  PubMed  Google Scholar 

  43. Hughes ESR, Cuthbertson AM, Carden ABG. The surgical management of acute diverticulitis. Med J Aust 1963;1: 780–782.

    Google Scholar 

  44. Hinchey EJ, Schaal PG, Richards GK. Treatment of perforated diverticular disease of the colon. Adv Surg 1978;12:85–109.

    CAS  PubMed  Google Scholar 

  45. Makela J, Vuolio S, Kiviniemi H, et al. Natural history of diverticular disease: when to operate? Dis Colon Rectum 1998;41:1523–1528.

    Article  CAS  PubMed  Google Scholar 

  46. Chautems R, Ambrosetti P, Ludwig A, et al. Long‐term follow‐up after first acute episode of sigmoid diverticulitis: is surgery mandatory? Dis Colon Rectum 2001;44:A12.

    Google Scholar 

  47. Boles RS, Jordan SM. The clinical significance of diverticulosis. Gastroenterology 1958;35:579–581.

    PubMed  Google Scholar 

  48. Fearnhead NS, Mortensen NJ. Clinical features and differential diagnosis of diverticular disease. Best Pract Res Clin Gastroenterol 2002;16:577–593.

    Article  PubMed  Google Scholar 

  49. Farmakis N, Tudor RG, Keighley MR. The 5‐year natural history of complicated diverticular disease. Br J Surg 1994;81: 733–735.

    Article  CAS  PubMed  Google Scholar 

  50. Horner JL. Natural history of diverticulosis of the colon. Am J Dig Dis 1958;3:343–350.

    Article  CAS  PubMed  Google Scholar 

  51. Polk HC, Tuckson WB, Miller FB. The atypical presentations of diverticulitis. In: Welch JP, Cohen JL, Sardella WV, Vignati PV, eds. Diverticular Disease, Management of the Difficult Surgical Case. Baltimore: Williams & Wilkins; 1998:384–393.

    Google Scholar 

  52. Gordon PH. Diverticular disease of the colon. In: Gordon PH, Nivatvongs S, eds. Principles and Practice of Surgery for the colon, Rectum and Anus. 2nd ed. St. Louis: Quality Medical Publishing; 1999:975–1043.

    Google Scholar 

  53. Davidson R, Sweeney WB. Endoluminal stenting for benign colonic obstruction. Surg Endosc 1998;12:353–354.

    Article  CAS  PubMed  Google Scholar 

  54. Tamim WL, Ghellai A, Counihan TC, et al. Experience with endoluminal colonic wall stents for the management of large bowel obstruction for benign and malignant disease. Arch Surg 2000;135:434–438.

    Article  CAS  PubMed  Google Scholar 

  55. Paul L, Pinto I, Gomez H, et al. Metallic stents in the treatment of benign diseases of the colon: preliminary experience in 10 cases. Radiology 2002;223:715–722.

    Article  PubMed  Google Scholar 

  56. Siminovitch JMP, Fazio VW. Obstructive uropathy secondary to sigmoid diverticulitis. Dis Colon Rectum 1980;23:504–507.

    Article  CAS  PubMed  Google Scholar 

  57. Sakhnini E, Lahat A, Melzer E, et al. Early colonoscopy in patients with acute diverticulitis: results of a prospective pilot study. Endoscopy 2004;36:504–507.

    Article  CAS  PubMed  Google Scholar 

  58. Ghorai S, Ulbright TM, Rex DK. Endoscopic findings of diverticular inflammation in colonoscopy patients without clinical acute diverticulitis: prevalence and endoscopic spectrum. Am J Gastroenterol 2003;98:802–806.

    Article  PubMed  Google Scholar 

  59. Hachigian MP, Honickman S, Eisenstat TE, et al. Computed tomography in the initial management of acute left‐sided diverticulitis. Dis Colon Rectum 1992;35:1123–1129.

    Article  CAS  PubMed  Google Scholar 

  60. Hollerweger A, Rettenbacher T, Macheiner P, et al. Sigmoid diverticulitis: value of transrectal sonography in addition to transabdominal sonography. AJR Am J Roentgenol 2000;175: 1155–1160.

    CAS  PubMed  Google Scholar 

  61. Schreyer AG, Furst A, AghaA, et al. Magnetic resonance imaging based colonography for diagnosis and assessment of diverticulosis and diverticulitis. Int J Colorectal Dis 2004;19: 474–480.

    Article  PubMed  Google Scholar 

  62. Cohn KH, Weimar JA, Fani K, et al. Adenocarcinoma arising within a colonic diverticulum: report of two cases and review of the literature. Surgery 1993;113:223–226.

    CAS  PubMed  Google Scholar 

  63. Stefansson T, Ekbom A, Sparen P, et al. Association between sigmoid diverticulitis and left‐sided colon cancer: a nested, population‐based, case control study. Scand J Gastroenterol 2004;39:743–747.

    Article  CAS  PubMed  Google Scholar 

  64. Stefansson T, Ekbom A, Sparen P, et al. Increased risk of left sided colon cancer in patients with diverticular disease. Gut 1993;34:499–502.

    Article  CAS  PubMed  Google Scholar 

  65. Stefansson T, Ekbom A, Sparen P, et al. Cancers among patients diagnosed as having diverticular disease of the colon. Eur J Surg 1995;161:755–760.

    CAS  PubMed  Google Scholar 

  66. Berman IR, Corman ML, Coller JA, et al. Late‐onset Crohn's disease in patients with colonic diverticulitis. Dis Colon Rectum 1979;22:524.

    Article  CAS  PubMed  Google Scholar 

  67. Lederman ED, McCoy G, Conti DJ, et al. Diverticulitis and polycystic kidney disease. Am Surg 2000;66:200–203.

    CAS  PubMed  Google Scholar 

  68. Dominguez FE, Albrecht KH, HeemannU, et al. Prevalence of diverticulosis and incidence of bowel perforation after kidney transplantation in patients with polycystic kidney disease. Transpl Int 1998;11:28–31.

    Article  Google Scholar 

  69. Lederman ED, Conti DJ, Lempert N, et al. Complicated diverticulitis following renal transplantation. Dis Colon Rectum 1998;41:613–618.

    Article  CAS  PubMed  Google Scholar 

  70. Pirenne J, Lledo‐Garcia E, Benedetti E, et al. Colon perforation after renal transplantation: a single‐institution review. Clin Transplant 1997;11:88–93.

    CAS  PubMed  Google Scholar 

  71. Acosta JA, Grebenc ML, Doberneck RC, et al. Colonic diverticular disease in patients 40 years old or younger. Am Surg 1992;58:605–607.

    CAS  PubMed  Google Scholar 

  72. Schauer PR, Ramos R, Ghiatas AA, et al. Virulent diverticular disease in young obese men. Am J Surg 1992;164:443–446.

    Article  CAS  PubMed  Google Scholar 

  73. Schweitzer J, Casillas RA, Collins JC. Acute diverticulitis in the young adult is not “virulent.” Am Surg 2002;68:1044–1047.

    PubMed  Google Scholar 

  74. Minardi AJ Jr, Johnson LW, Sehon JK, et al. Diverticulitis in the young patient. Am Surg 2001;67:458–461.

    PubMed  Google Scholar 

  75. Reisman Y, Ziv Y, Kravrovitc D, et al. Diverticulitis: the effect of age and location on the course of disease. Int J Colorectal Dis 1999;14:250–254.

    Article  CAS  PubMed  Google Scholar 

  76. Spivak H, Weinrauch S, Harvey JC, et al. Acute colonic diverticulitis in the young. Dis Colon Rectum 1997;40: 570–574.

    Article  CAS  PubMed  Google Scholar 

  77. Ambrosetti P, Robert JH, Witzig JA, et al. Acute left colonic diverticulitis: a prospective analysis of 226 consecutive cases. Surgery 1994;115:546–550.

    CAS  PubMed  Google Scholar 

  78. Ambrosetti P, Robert JH, Witzig JA, et al. Acute left colonic diverticulitis in young patients. J Am Coll Surg 1994;179: 156–160.

    CAS  PubMed  Google Scholar 

  79. Anderson DN, Driver CP, Davidson AI, et al. Diverticular disease in patients under 50 years of age. J R Coll Surg Edinb 1997;42:102–104.

    CAS  PubMed  Google Scholar 

  80. Biondo S, Pares D, Marti RagueJ, et al. Acute colonic diverticulitis in patients under 50 years of age. Br J Surg 2002;89: 1137–1141.

    Article  CAS  PubMed  Google Scholar 

  81. Cunningham MA, Davis JW, Kaups KL. Medical versus surgical management of diverticulitis in patients under age 40. Am J Surg 1997;174:733–735.

    Article  CAS  PubMed  Google Scholar 

  82. Guzzo J, Hyman N. Diverticulitis in young patients: is resection after a single attack always warranted? Dis Colon Rectum 2004;47:1187–1190.

    Article  PubMed  Google Scholar 

  83. West SD, Robinson EK, Delu AN, et al. Diverticulitis in the younger patient. Am J Surg 2003;186:743–746.

    Article  PubMed  Google Scholar 

  84. Vignati PV, Welch JP, Cohen JL. Long‐term management of diverticulitis in young patients. Dis Colon Rectum 1995;38:627–629.

    Article  CAS  PubMed  Google Scholar 

  85. Poletti PA, Platon A, Rutschmann O, et al. Acute left colonic diverticulitis: can CT findings be used to predict recurrence? AJR Am J Roentgenol 2004;182:1159–1165.

    PubMed  Google Scholar 

  86. Chautems RC, Ambrosetti P, Ludwig A, et al. Long‐term follow‐up after first acute episode of sigmoid diverticulitis: is surgery mandatory? A prospective study of 118 patients. Dis Colon Rectum 2002;45:962–966.

    Article  CAS  PubMed  Google Scholar 

  87. Ambrosetti P, Robert J, Witzig JA, et al. Prognostic factors from computed tomography in acute left colonic diverticulitis. Br J Surg 1992;79:117–119.

    Article  CAS  PubMed  Google Scholar 

  88. Lo CY, Chu KW. Acute diverticulitis of the right colon. Am J Surg 1996;171:244–246.

    Article  CAS  PubMed  Google Scholar 

  89. Komuta K, Yamanaka S, Okada K, et al. Toward therapeutic guidelines for patients with acute right colonic diverticulitis. Am J Surg 2004;187:233–237.

    Article  PubMed  Google Scholar 

  90. Thorson AG, Ternent CA. Cecal diverticulitis. In: Welch JP, Cohen JL, Sardella WV, Vignati PV, eds. Diverticular Disease, Management of the Difficult Surgical Case. Baltimore: Williams & Wilkins; 1998:428–441.

    Google Scholar 

  91. Scerpella PR, Bodensteiner JA. Giant sigmoid diverticula. Report of two cases. Arch Surg 1989;134:1244–1246.

    Google Scholar 

  92. Mainzer F, Minagi H. Giant sigmoid diverticulum. AJR Am J Roentgenol 1971;113:352–353.

    CAS  Google Scholar 

  93. de Oliveira NC, Welch JP. Giant diverticula of the colon. In: Welch JP, Cohen JL, Sardella WV, Vignati PV, eds. Diverticular Disease, Management of the Difficult Surgical Case. Baltimore: Williams & Wilkins; 1998:410–418.

    Google Scholar 

  94. Aldoori W, Ryan‐Harshman M. Preventing diverticular disease. Review of recent evidence on high‐fibre diets. Can Fam Physician 2002;48:1632–1637.

    PubMed  Google Scholar 

  95. Aldoori WH, Giovannucci EL, RockettHR, et al. A prospective study of dietary fiber types and symptomatic diverticular disease in men. J Nutr 1998;128:714–719.

    CAS  PubMed  Google Scholar 

  96. Aldoori WH, Giovannucci EL, Rimm EB, et al. Prospective study of physical activity and the risk of symptomatic diverticular disease in men. Gut 1995;36:276–282.

    Article  CAS  PubMed  Google Scholar 

  97. Marlett JA, McBurney MI, Slavin JL. Position of the American Dietetic Association: health implications of dietary fiber. J Am Diet Assoc 2002;102:993–1000.

    Article  PubMed  Google Scholar 

  98. Brook I, Frazier EH. Aerobic and anaerobic microbiology in intra‐abdominal infections associated with diverticulitis. J Med Microbiol 2000;49:827–830.

    CAS  PubMed  Google Scholar 

  99. Kronborg O. Treatment of perforated sigmoid diverticulitis: a prospective randomized trial. Br J Surg 1993;80:505–507.

    Article  CAS  PubMed  Google Scholar 

  100. Bahadursingh AM, Virgo KS, Kaminski DL, et al. Spectrum of disease and outcome of complicated diverticular disease. Am J Surg 2003;186:696–701.

    Article  PubMed  Google Scholar 

  101. Schilling MK, Maurer CA, Kollmar O, et al. Primary vs. secondary anastomosis after sigmoid colon resection for perforated diverticulitis (Hinchey Stage III and IV): a prospective outcome and cost analysis. Dis Colon Rectum 2001;44: 699–703.

    Article  CAS  PubMed  Google Scholar 

  102. Farthmann EH, Ruckauer KD, Haring RU. Evidence‐based surgery diverticulitis: a surgical disease? Langenbecks Arch Surg 2000;385:143–151.

    Article  CAS  PubMed  Google Scholar 

  103. Chandra V, Nelson H, Larson DR, et al. Impact of primary resection on the outcome of patients with perforated diverticulitis. Arch Surg 2004;139:1221–1224.

    Article  PubMed  Google Scholar 

  104. Zeitoun G, Laurent A, Rouffet F, et al. Multicentre, randomized clinical trial of primary versus secondary sigmoid resection in generalized peritonitis complicating sigmoid diverticulitis. Br J Surg 2000;87:1366–1374.

    Article  CAS  PubMed  Google Scholar 

  105. Rothenberger DA, Wiltz O. Surgery for complicated diverticulitis. Surg Clin North Am 1993;73:975–992.

    CAS  PubMed  Google Scholar 

  106. Maggard MA, Chandler CF, Schmit PJ, et al. Surgical diverticulitis: treatment options. Am Surg 2001;67:1185–1189.

    CAS  PubMed  Google Scholar 

  107. Guenaga KF, Matos D, Castro AA, et al. Mechanical bowel preparation for elective colorectal surgery. Cochrane Database Syst Rev 2003;2:CD001544.

    PubMed  Google Scholar 

  108. Maggard MA, Zingmond D, O'ConnellJB, et al. What proportion of patients with an ostomy (for diverticulitis) get reversed? Am Surg 2004;70:928–931.

    PubMed  Google Scholar 

  109. Desai DC, Brennan EJ Jr, Reilly JF, et al. The utility of the Hartmann procedure. Am J Surg 1998;175:152–154.

    Article  CAS  PubMed  Google Scholar 

  110. Haas PA, Fox TA Jr. The fate of the forgotten rectal pouch after Hartmann's procedure without reconstruction. Am J Surg 1990;159:106–110.

    Article  CAS  PubMed  Google Scholar 

  111. Pessaux P, Muscari F, Ouellet JF, et al. Risk factors for mortality and morbidity after elective sigmoid resection for diverticulitis: prospective multicenter multivariate analysis of 582 patients. World J Surg 2004;28:92–96.

    Article  PubMed  Google Scholar 

  112. Elliott TB, Yego S, Irvin TT, Elliott TB, Yego S, Irvin TT. Five‐year audit of the acute complications of diverticular disease. Br J Surg 1997;84:535–539.

    Article  CAS  PubMed  Google Scholar 

  113. Vernava AM III, Longo WE. Postoperative anastomotic complications. In: Hicks TC, Beck DE, Opelka FG, Timmcke AE, eds. Complications in Colon and Rectal Surgery. Baltimore: Williams & Wilkins; 1996:82–98.

    Google Scholar 

  114. Roach MB, Donaldson DS. Urologic complications of colorectal surgery. In: Hicks TC, Beck DE, Opelka FG, Timmcke AE, eds. Complications in Colon and Rectal Surgery. Baltimore: Williams & Wilkins; 1996:99–117.

    Google Scholar 

  115. Leff EI, Groff W, Rubin RJ, et al. Use of ureteral catheters in colonic and rectal surgery. Dis Colon Rectum 1982;25:457–460.

    Article  CAS  PubMed  Google Scholar 

  116. Practice parameters for the treatment of sigmoid diverticulitis. The Standards Task Force. The American Society of Colon and Rectal Surgeons. Dis Colon Rectum 2000;43:289.

    Google Scholar 

  117. Richards RJ, Hammitt JK. Timing of prophylactic surgery in prevention of diverticulitis recurrence: a cost‐effectiveness analysis. Dig Dis Sci 2002;47:1903–1908.

    Article  PubMed  Google Scholar 

  118. Salem L, Veenstra DL, Sullivan SD, et al. The timing of elective colectomy in diverticulitis: a decision analysis. J Am Coll Surg 2004;199:904–912.

    Article  PubMed  Google Scholar 

  119. Sarin S, Boulos PB. Long‐term outcome of patients presenting with acute complications of diverticular disease. Ann R Coll Surg Engl 1994;76:117–120.

    CAS  PubMed  Google Scholar 

  120. Lorimer JW. Is prophylactic resection valid as an indication for elective surgery in diverticular disease? Can J Surg 1997; 40:445–448.

    CAS  PubMed  Google Scholar 

  121. Thorn M, Graf W, Stefansson T, et al. Clinical and functional results after elective colonic resection in 75 consecutive patients with diverticular disease. Am J Surg 2002;183:7–11.

    Article  PubMed  Google Scholar 

  122. Moss RL, Ryan JA Jr. Management of enterovesical fistulas. Am J Surg 1990;159:514–517.

    Article  CAS  PubMed  Google Scholar 

  123. Wong WD, Wexner SD, Lowry A, et al. Practice parameters for the treatment of sigmoid diverticulitis: supporting documentation. The Standards Task Force. The American Society of Colon and Rectal Surgeons. Dis Colon Rectum 2000;43: 290–297.

    Article  CAS  PubMed  Google Scholar 

  124. Thaler K, Baig MK, Berho M, et al. Determinants of recurrence after sigmoid resection for uncomplicated diverticulitis. Dis Colon Rectum 2003;46:385–388.

    Article  PubMed  Google Scholar 

  125. Dwivedi A, Chahin F, Agrawal S, et al. Laparoscopic colectomy vs. open colectomy for sigmoid diverticular disease. Dis Colon Rectum 2002;45:1309–1314.

    Article  PubMed  Google Scholar 

  126. Senagore AJ, Duepree HJ, Delaney CP, et al. Cost structure of laparoscopic and open sigmoid colectomy for diverticular disease: similarities and differences. Dis Colon Rectum 2002;45:485–490.

    Article  PubMed  Google Scholar 

  127. Gervaz P, Pikarsky A, Utech M, et al. Converted laparoscopic colorectal surgery. Surg Endosc 2001;15:827–832.

    Article  CAS  PubMed  Google Scholar 

  128. Schlachta CM, Mamazza J, Seshadri PA, et al. Predicting conversion to open surgery in laparoscopic colorectal resections. A simple clinical model. Surg Endosc 2000;14:1114–1117.

    Article  CAS  PubMed  Google Scholar 

  129. Schwandner O, Farke S, Fischer F, et al. Laparoscopic colectomy for recurrent and complicated diverticulitis: a prospective study of 396 patients. Langenbecks Arch Surg 2004; 389:97–103.

    Article  CAS  PubMed  Google Scholar 

  130. Schwandner O, Farke S, Bruch HP. Laparoscopic colectomy for diverticulitis is not associated with increased morbidity when compared with non‐diverticular disease. Int J Colorectal Dis 2005;20(2):165–172.

    Article  CAS  PubMed  Google Scholar 

  131. Vargas HD, Ramirez RT, Hoffman GC, et al. Defining the role of laparoscopic‐assisted sigmoid colectomy for diverticulitis. Dis Colon Rectum 2000;43:1726–1731.

    Article  CAS  PubMed  Google Scholar 

  132. Thaler K, Weiss EG, Nogueras JJ, et al. Recurrence rates at minimum 5‐year follow‐up: laparoscopic versus open sigmoid resection for uncomplicated diverticulitis. Surg Laparosc Endosc Percutan Tech 2003;13:325–327.

    Article  PubMed  Google Scholar 

Download references

Authors
  1. Alan G. Thorson
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Stanley M. Goldberg
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Professor of Surgery, Mayo Clinic College of Medicine, Chairman, Division of Colon and Rectal Surgery, Mayo Clinic Foundation, Rochester, MN, USA

    Bruce G. Wolff MD, FASCRS (Senior Editors) (Senior Editors)

  2. Professor of Surgery, Chief, Section of Colorectal Surgery, Washington University School of Medicine, St. Louis, MO, USA

    James W. Fleshman MD, FASCRS (Senior Editors) (Senior Editors)

  3. Chairman, Department of Colon and Rectal Surgery, Ochsner Clinic Foundation, New Orleans, LA, USA

    David E. Beck MD, FASCRS (Senior Editors) (Senior Editors)

  4. Professor of Surgery, Mayo Clinic College of Medicine, Consultant, Colon and Rectal Surgery, Mayo Clinic and Mayo Foundation, Rochester, MN, USA

    John H. Pemberton MD, FASCRS (Senior Editors) (Senior Editors)

  5. Chief of Staff, Cleveland Clinic Florida, Weston, FL, USA

    Steven D. Wexner MD, FASCRS (Senior Editors) (Senior Editors)

  6. Victor W. Fazio Chair of Colorectal Surgery, Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA

    James M. Church BSc, MBChB, MMed Sci, FASCRS (Associate Editors) (Associate Editors)

  7. Professor of Surgery, Chief, Section of Colon and Rectal Surgery, Department of Surgery, University of California, San Francisco, San Francisco, CA, USA

    Julio Garcia-Aguilar MD, PhD, FASCRS (Associate Editors) (Associate Editors)

  8. Department of Colon and Rectal Surgery, Lahey Clinic, Burlington, MA, USA

    Patricia L. Roberts MD, FASCRS (Associate Editors) (Associate Editors)

  9. Professor of Surgery, Head, Section of Colon and Rectal Surgery, Rush University Medical Center, Chicago, IL, USA

    Theodore J. Saclarides MD, FASCRS (Associate Editors) (Associate Editors)

  10. Division of Colon and Rectal Surgery, Department of Surgery, University of California, Irvine Medical Center, Orange, CA, USA

    Michael J. Stamos MD, FASCRS (Associate Editors) (Associate Editors)

Appendix: Practice Parameters for the Treatment of Sigmoid Diverticulitis

Appendix: Practice Parameters for the Treatment of Sigmoid Diverticulitis

Prepared by The Standards Task Force, The American Society of Colon and Rectal Surgeons.

The initial evaluation of a new patient with suspected acute diverticulitis should include a problem‐specific history and physical examination; a complete blood count, urinalysis, and plain abdominal radiographs may be useful in selected clinical scenarios. Computerized tomography scan of the abdomen and pelvis is usually the most appropriate imaging modality in the assessment of suspected diverticulitis. Contrast enema x‐ray, cystography, ultrasound, and endoscopy are sometimes useful in the initial evaluation of a patient with suspected acute diverticulitis.

Nonoperative treatment typically includes dietary modification and oral or intravenous antibiotics. Radiologically guided percutaneous drainage is usually the most appropriate treatment for patients with a large diverticular abscess.

After resolution of an initial episode of acute diverticulitis, the colon should be adequately evaluated to confirm the diagnosis. Colonoscopy or contrast enema x‐ray (probably with flexible sigmoidoscopy) is appropriate to exclude other diagnoses, primarily cancer, ischemia, and inflammatory bowel disease.

Urgent sigmoid colectomy is required for patients with diffuse peritonitis or for those who fail nonoperative management of acute diverticulitis. The decision to recommend elective sigmoid colectomy after recovery from acute diverticulitis should be made on a case‐by‐case basis. Elective colon resection should typically be advised if an episode of complicated diverticulitis is treated nonoperatively. The resection should be carried proximally to compliant bowel and extend distally to the upper rectum. When a colectomy for diverticular disease is performed, a laparoscopic approach is appropriate in selected patients.

Reprinted from Dis Colon Rectum 2006; 49: 939–944. Copyright © 2006. All rights reserved. American Society of Colon and Rectal Surgeons.Footnote 1

Rights and permissions

Reprints and permissions

Copyright information

© 2007 Springer Science+Business Media, LLC

About this entry

Cite this entry

Thorson, A.G., Goldberg, S.M. (2007). Benign Colon: Diverticular Disease. In: Wolff, B.G., et al. The ASCRS Textbook of Colon and Rectal Surgery. Springer, New York, NY. https://doi.org/10.1007/978-0-387-36374-5_18

Download citation

  • DOI: https://doi.org/10.1007/978-0-387-36374-5_18

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-0-387-24846-2

  • Online ISBN: 978-0-387-36374-5

  • eBook Packages: MedicineReference Module Medicine

Publish with us

Policies and ethics

Search

Navigation