Diverticular Disease of the Colon: Review and Update

Christopher N. Andrews, MD, Gastroenterology Fellow, Faculty of Medicine, University of Calgary, Calgary, AB.
Eldon A. Shaffer, MD, FRCPC, Professor of Medicine, Division of Gastroenterology, Faculty of Medicine, University of Calgary, Calgary, AB.

Diverticular disease of the colon (or diverticulosis) is an anatomical description of saccular outpouchings of mucosa through the wall of the colon. It is very common in the Western world, and its prevalence is rising. This paper will briefly review the epidemiology and pathophysiology of diverticular disease, followed by a focus on the diagnosis and management of the two most common complications of the disease: diverticulitis and diverticular bleeding.

The true prevalence of diverticulosis is unknown, but autopsy reports suggest that up to half of patients over 60 years are affected.1 The frequency increases with age and is much higher in developed societies in which fibre intake is lower. In the Western world, the most commonly affected site in the colon is the sigmoid colon, sometimes with more proximal involvement.2 However, in Asian countries diverticulae tend to be right-sided (in the ascending colon) and fewer in number. The reason for this difference is unknown.

The colon is made up of circumferential and longitudinal (taenia coli) muscle layers, which act in unison to propel stool towards the rectum.