Korean J Gastroenterol.  2022 Jun;79(6):233-243. 10.4166/kjg.2022.072.

Diagnosis and Treatment of Colonic Diverticular Disease

• Kim YS

• KMID: 2530696
• DOI: http://doi.org/10.4166/kjg.2022.072

Abstract

Colonic diverticulosis is one of the most common conditions of the digestive system and patients generally remain asymptomatic. However, about 20% of patients develop symptomatic diverticular disease such as acute diverticulitis or diverticular hemorrhage, and these have become a huge burden on healthcare systems worldwide. Recent understanding of the pathophysiology of diverticulosis and diverticular disease suggests the role of multiple factors including genetic and environment. Based on this understanding, a preventive strategy to reduce the risk factors of diverticulosis and diverticular disease is highly recommended. The diagnosis of the acute diverticulitis relies on imaging modalities such as an abdominal-pelvic CT scan together with symptoms and signs. Treatment of diverticular disease should be individualized and include modification of lifestyle, use of antibiotics, and surgery. Recent guidelines recommend pursuing less aggressive treatment for patients with acute diverticulitis. This review will provide an overview of both the existing and evolving understanding regarding colonic diverticulosis and diverticular disease and can help clinicians in the management of their patients with diverticular disease.

Keyword

Diverticulosis; colonic; Diverticulitis; Risk factors; Therapy

Figure

• 

  Fig. 1 Colonoscopic findings. (A) Multiple diverticula are observed in the ascending colon and cecum. (B) Several diverticula are impacted with feces without inflammation. (C) Incidental diverticulitis is observed during colonoscopy. The opening of the diverticulum shows edematous and hyperemic changes and mucopurulent exudate around the diverticulum.

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  Fig. 2 Abdominal-pelvic computed tomography (CT) findings. (A) Acute right-sided diverticulitis. The axial CT scan shows wall thickening of the ascending colon with a pericolic infiltration. (B) Acute left-sided diverticulitis. The axial CT scan shows marked enhanced wall thickening of the sigmoid colon with inflamed diverticula. Pericolic infiltration and minimal fluid collection are also noted.

• 

  Fig. 3 Acute diverticular bleeding. (A) Abdominal-pelvic computed tomography scan shows extravasation of dye, suggesting active bleeding in the ascending colon. (B) Colonoscopy reveals fresh blood gushes out from the opening of the diverticulum. (C) Endoscopic hemostasis with epinephrine injection and thermal coagulation is done to control the bleeding. (D) Active bleeding is controlled after endoscopic hemostasis.

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