#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

Diverticular Disease of Colon


Authors: Z. Adamová
Authors‘ workplace: Vsetínská nemocnice a. s., chirurgické oddělení, primář: MUDr. Jaroslav Sankot
Published in: Rozhl. Chir., 2011, roč. 90, č. 8, s. 463-477.
Category: Monothematic special - Original

Overview

Diverticular disease of the colon is one from the most common diseases, especially in the Western world. This disease is symptomatic in only 20–30% patients, but it could be the cause of considerable morbidity and mortality. Pathogenesis is not entirely known. Presumably there are more causing factors – intestinal dysmotility, that is induced by abnormal regulation, structural changes of the colonic wall, genetic factors, diet. The aim of this article is to review the state of our nowadays knowledge in pathogenesis, symptomatology, diagnostic methods and treatment.

Key words:
diverticulosis – diverticulitis – enterorhagia


Sources

1. Strate, L. L., Liu, Y. L., Syngal, S., Aldoori, W. H., Giovannucci, E. L. Nut, corn, and popcorn consumption and the incidence of diverticular disease. JAMA, 2008 Aug 27; 300 (8): 907–914.

2. Touzios, J. G., Dozois, E. J. Diverticulosis and acute diverticulitis. Gastroenterol. Clin. North Am., 2009 Sep; 38 (3): 513–525.

3. Etzioni, D. A., Cannom, R. R., Ault, G. T., Beart, R. W. Jr, Kaiser, A. M. Diverticulitis in California from 1995 to 2006: increased rates of treatment for younger patients. Am. Surg., 2009 Oct; 75 (10): 981–985.

4. Chapman, M. D, Davies M., Wolff B., et al. Complicated Diverticulitis Is It Time to Rethink the Rules? Ann. Surg., 2005 October; 242 (4): 576–583.

5. Hjern, F., Johansson, C., Mellgren, A., Baxter, N. N., Hjern, A. Diverticular disease and migration – the influence of acculturation to a Western lifestyle on diverticular disease. Aliment Pharmacol. Ther., 2006 Mar 15; 23 (6): 797–805.

6. Kiguli-Malwadde, E., Kasozi, H. Diverticular disease of the colon in Kampala, Uganda. Afr. Health Sci., 2002 Apr; 2 (1): 29–32.

7. Painter, N. S., Burkitt, D. P. Diverticular disease of the colon: a deficiency disease of Western civilization. Br. Med. J., 1971 May 22; 2 (5759): 450–454.

8. Gear, J. S., Ware, A., Fursdon, P., Mann, J. I., Nolan, D. J., Brodribb, A. J., Vessey, M. P. Symptomless diverticular disease and intake of dietary fibre. Lancet, 1979 Mar 10; 1 (8115): 511–514.

9. Fisher, N., Berry, C. S., Fearn, T., Gregory, J. A., Hardy, J. Cereal dietary fiber consumption and diverticular disease: a lifespan study in rats. Am. J. Clin. Nutr., 1985 Nov; 42 (5): 788–804.

10. Wess, L., Eastwood, M. A., Edwards, C. A., Busuttil, A., Miller, A. Collagen alteration in an animal model of colonic diverticulosis. Gut, 1996 May; 38 (5): 701–706.

11. Wess, L., Eastwood, M., Busuttil, A., Edwards, C., Miller, A. An association between maternal diet and colonic diverticulosis in an animal model. Gut, 1996 Sep; 39 (3): 423–427.

12. Commane, D. M., Arasaradnam, R. P., Mills, S., Mathers, J. C., Bradburn, M. Diet, ageing and genetic factors in the pathogenesis of diverticular disease. World J. Gastroenterol., 2009 May 28; 15 (20): 2479–2488.

13. Papagrigoriadis, S., Macey, L., Bourantas, N., Rennie, J. A. Smoking may be associated with complications in diverticular disease. Br. J. Surg., 1999 Jul; 86 (7): 923–926.

14. Aldoori, W. H., Giovannucci, E. L., Rimm, E. B., Wing, A. L., Trichopoulos, D. V., Willett, W. C. A prospective study of alcohol, smoking, caffeine, and the risk of symptomatic diverticular disease in men. Ann. Epidemiol., 1995 May; 5 (3): 221–228.

15. Wald, A., Back, C., Bayless, T. M. Effect of caffeine on the human small intestine. Gastroenterology, 1976 Nov; 71 (5): 738–742.

16. Mpofu, S., Mpofu, C. M., Hutchinson, D., Maier, A. E., Dodd, S. R., Moots, R. J. Steroids, non-steroidal anti-inflammatory drugs, and sigmoid diverticular abscess perforation in rheumatic conditions. Ann. Rheum. Dis., 2004 May; 63(5): 588–590.

17. Heaton, K. W., Thompson, W. G. Exercise and diverticular disease. BMJ, 1995 May 20; 310 (6990): 1332.

18. Simpson, J., Scholefield, J. H., Spiller, R. C. Pathogenesis of colonic diverticula. Br. J. Surg., 2002 May; 89 (5): 546–554.

19. Commane, D. M., Arasaradnam, R. P., Mills, S., Mathers, J. C., Bradburn, M. Diet, ageing and genetic factors in the pathogenesis of diverticular disease. World J. Gastroenterol., 2009 May 28; 15 (20): 2479–2488.

20. Stefánsson, T., Ekbom, A., SparŹn, P., PĆhlman, L. Increased risk of left sided colon cancer in patients with diverticular disease. Gut, 1993 Apr; 34 (4): 499–502.

21. Morini, S., de Angelis, P., Manurita, L., Colavolpe, V. Association of colonic diverticula with adenomas and carcinomas. A colonoscopic experience. Dis. Colon Rectum, 1988 Oct; 31 (10): 793–796.

22. Soran, A., Harlak, A., Wilson, J. W., Nesbitt, L., Lembersky, B. C., Wienad, H. S., O’Connell, M. J. Diverticular disease in patients with coloncancer:subgroup analysis of national surgical adjuvant breast and bowel project protocol C-06. Clin. Colorectal Cancer, 2006 Jul; 6 (2): 140–145.

23. Kazil, P., Kazilová, M. Divertikulární nemoc tračníku. Grada, 2007.

24. Parra-Blanco, A. Colonic diverticular disease: pathophysiology and clinical picture. Digestion, 2006; 73 Suppl 1: 47-57. Epub 2006 Feb 8.

25. Hobson, K. G., Roberts, P. L. Etiology and pathophysiology of diverticular disease. Clin. Colon Rectal Surg., 2004 Aug; 17 (3): 147–153.

26. Bode, M. K., Karttunen, T. J., Makela, J., Risteli, L., Risteli, J. Type I and III collagens in human colon cancer and diverticulosis. Scand. J. Gastroenterol., 2000; 35: 747–752.

27. Stumpf, M., Krones, C. J., Klinge, U., Rosch, R., Junge, K., Schumpelick, V. Collagen in colon disease. Hernia, 2006 Dec; 10 (6): 498–501.

28. Bassotti, G., Battaglia, E., De Roberto, G., Morelli, A., Tonini, M., Villanacci, V. Alterations in colonic motility and relationship to pain in colonic diverticulosis. Clin. Gastroenterol. Hepatol., 2005 Mar; 3 (3): 248–253.

29. Manousos, O. N., Truelove, S. C., Lumsden, K. Transit times of food in patients with diverticulosis or irritable colon syndrome and normal subjects. Br. Med. J., 1967 Sep 23; 3 (5568): 760–762.

30. Shafik, A., Ahmed, I., Shafik, A. A., El Sinaj, O. Diverticular disease: electrophysiologic study and a new concept of pathogenesis. World J. Surg., 2004 Apr; 28 (4): 411–415. Epub 2004 Mar 4.

31. Huizinga, J. D., Waterfall, W. E., Stern, H. S. Abnormal response to cholinergic stimulation in the circular muscle layer of the human colon in diverticular disease. Scand. J. Gastroenterol., 1999 Jul; 34 (7): 683–688.

32. Tomita, R., Fujisaki, S., Tanjoh, K., Fukuzawa, M. Role of nitric oxide in the left-sided colon of patients with diverticular disease. Hepatogastroenterology, 2000 May-Jun; 47 (33): 692–696.

33. Bassotti, G., Battaglia, E., Bellone, G., Dughera, L., Fisogni, S., Zambelli, C., Morelli, A., Mioli, P., Emanuelli, G., Villanacci, V. Interstitial cells of Cajal, enteric nerves, and glial cells in colonic diverticular disease. J. Clin. Pathol., 2005 Sep; 58 (9): 973–977.

34. Guagnini, F., Valenti, M., Mukenge, S., Matias, I., Bianchetti, A., Di Palo, S., Ferla, G., Di Marzo, V., Croci, T. Neural contractions in colonic strips from patients with diverticular disease: role of endocannabinoids and substance P. Gut, 2006 Jul; 55 (7): 946–953. Epub 2006 Jan 19.

35. Burcher, E., Shang, F., Warner, F. J., Du, Q., Lubowski, D. Z., King, D. W., Liu, L. Tachykinin NK2 receptor and functional mechanisms in human colon: changes with indomethacin and in diverticular disease and ulcerative colitis. J. Pharmacol. Exp. Ther., 2008 Jan; 324 (1): 170–178. Epub 2007 Oct 24.

36. Banerjee, S., Akbar, N., Moorhead, J., Rennie, J. A., Leather, A. J., Cooper, D., Papagrigoriadis, S. Increased presence of serotonin-producing cells in colons with diverticular disease may indicate involvement in the pathophysiology of the condition. Int. J. Colorectal. Dis., 2007 Jun; 22 (6): 643–649. Epub 2006 Nov 4.

37. Mimura, T., Bateman, A. C., Lee, R. L., Johnson, P. A., McDonald, P. J., Talbot, I. C., Kamm, M. A., MacDonald, T. T., Pender, S. L. Up-regulation of collagen and tissue inhibitors of matrix metalloproteinase in colonic diverticular disease. Dis. Colon Rectum, 2004 Mar; 47 (3): 371–378; discussion 378–379.

38. Stumpf, M., Cao, W., Klinge, U., Klosterhalfen, B., Kasperk, R., Schumpelick, V. Increased distribution of collagen type III and reduced expression of matrix metalloproteinase 1 in patients with diverticular disease. Int. J. Colorectal Dis., 2001 Sep; 16 (5): 271–275.

39. Rosemar, A., Ivarsson, M. L., Börjesson, L., Holmdahl, L. Increased concentration of tissue-degrading matrix metalloproteinases and their inhibitor in complicated diverticular disease. Scand. J. Gastroenterol., 2007 Feb; 42 (2): 215–220.

40. Kealy, W. F. Lymphoid tissue and lymphoid-glandular complexes of the colon: relation to diverticulosis. J. Clin. Pathol., 1976 Mar; 29 (3): 245–249.

41. Altaf, N., Geary, S., Ahmed, I. Giant colonic diverticulum. J. R. Soc. Med., 2005 Apr; 98(4): 169–170.

42. Freeman, H. J. Segmental colitis associated with diverticulosis syndrome. World J. Gastroenterol., 2008 Nov 14; 14 (42): 6442–6443.

43. Jansen, A., Harenberg, S., Grenda, U., Elsing, C. Risk factors for colonic diverticular bleeding: a Westernized community based hospital study. World J. Gastroenterol., 2009 Jan 28; 15 (4): 457–461.

44. Brouard, M. C., Chavaz, P., Borradori, L. Acute pustulosis of the legs in diverticulitis with sigmoid stenosis: an overlap between bowel-associated dermatosis-arthritis syndrome and pustular pyoderma gangrenosum. J. Eur. Acad. Dermatos. Venereol., 2004 Jan; 18(1): 89–92.

45. Pfeifer, J. Diverticulitis. Acta Chir. Iugosl., 2008; 55(3): 97–102.

46. Almeida, A. T., Melčo, L., Viamonte, B., Cunha, R., Pereira, J. M. Epiploic appendagitis: an entity frequently unknown to clinicians – diagnostic imaging, pitfalls, and look-alikes. AJR Am. J. Roentgenol., 2009 Nov; 193(5): 1243–1251.

47. Poletti, P. A., Platon, A., Rutschmann, O., Kinkel, K., Nyikus, V., Ghiorghiu, S., Morel, P., Terrier, F., Becker, C. D. Acute left colonic diverticulitis: can CT findings be used to predict recurrence? AJR Am. J. Roentgenol., 2004 May; 182 (5): 1159–1165.

48. Tursi, A., Brandimarte, G., Elišek, W., Giorgetti, G. M., Inchingolo, C. D., Aiello, F. Faecal calprotectin in colonic diverticular disease: a case-control study. Int. J. Colorectal Dis., 2009 Jan; 24 (1): 49–55. Epub 2008 Oct 22.

49. Gionchetti, P., Amadini, C., Rizzello, F., Venturi, A., Palmonari, V., Morselli, C., Romagnoli, R., Campieri, M. Probiotics – role in inflammatory bowel disease. Dig. Liver Dis., 2002 Sep; 34 Suppl 2: S58–62.

50. Fric, P., Zavoral, M. The effect of non-pathogenic Escherichia coli in symptomatic uncomplicated diverticular disease of the colon. Eur. J. Gastroenterol. Hepatol., 2003 Mar; 15(3): 313–315.

51. Tursi, A., Brandimarte, G., Giorgetti, G. M., Elisei, W. Mesalazine and/or Lactobacillus casei in maintaining long-term remission of symptomatic uncomplicated diverticular disease of the colon. Hepatogastroenterology, 2008 May-Jun; 55 (84): 916–920.

52. Dughera, L., Serra, A. M., Battaglia, E., Tibaudi, D., Navino, M., Emanuelli, G. Acute recurrent diverticulitis is prevented by oral administration of a polybacterial lysate suspension. Minerva Gastroenterol. Dietol., 2004 Jun; 50 (2): 149–153.

53. Tursi, A., Brandimarte, G., Elisei, W., Giorgetti, G. M., Inchingolo, C. D., Aiello, F. Effect of mesalazine on epithelial cell proliferation in colonic diverticular disease. Dig. Liver Dis., 2008 Sep; 40 (9): 737–742. Epub 2008 Apr 2.

54. Comparato, G., Fanigliulo, L., Cavallaro, L. G. Prevention of complications and symptomatic recurrences in diverticular disease with mesalazine: a 12-month follow-up. Dig. Dis. Sci., 2007 Nov; 52 (11): 2934–2941. Epub 2007 Apr 5.

55. Morris, C. R., Harvey, I. M., Stebbings, W. S. Do calcium channel blockers and antimuscarinics protect against perforated colonic diverticular disease? A case control study. Gut, 2003 Dec; 52(12): 1734–1737.

56. Latella, G., Pimpo, M. T., Sottili, S., Zippi, M., Viscido, A., Chiaramonte, M., Frieri, G. Rifaximin improves symptoms of acquired uncomplicated diverticular disease of the colon. Int. J. Colorectal Dis., 2003 Jan; 18 (1): 55–62. Epub 2002 May 9.

57. Stanule, B. E., Puccio, E., van Sonnenberg, E., Neff, C. C. Discussion. Preoperative percutaneous drainage of diverticular abscesses. Am. J. Surg., 1990 Jan; 159 (1): 99–104.

58. Ambrosetti, P., Chautems, R., Soravia, C., Peiris-Waser, N., Terrier, F. Long-term outcomeof mesocolic and pelvic diverticular abscesses of the left colon: a prospective study of 73 cases. Dis. Colon Rectum, 2005; 48: 787–791.

59. Brandt, D., Gervaz, P., Durmishi, Y., Platon, A., Morel, P., Poletti, P. A. Percutaneous CT scan-guided drainage vs. antibiotherapy alone for Hinchey II diverticulitis: a case-control study. Dis. Colon Rectum, 2006; 49: 1533–1538.

60. Farrell, J. J., Graeme-Cook, F., Kelsey, P. B. Treatment of bleeding colonic diverticula by endoscopic band ligation: an in-vivo and ex-vivo pilot study. Endoscopy, 2003 Oct; 35 (10): 823–829.

61. Alamili, M., Gögenur, I., Rosenberg, J. Acute complicated diverticulitis managed by laparoscopic lavage. Dis. Colon Rectum, 2009 Jul; 52 (7): 1345–1349.

62. Aydin, H. N., Remzi, F. H., Tekkis, P. P. Hartmann‘s reversal is associated with high postoperative adverse events. Dis. Colon Rectum, 2005, Nov; 48(11): 2117–2126.

63. Valverde, A., Msika, S., Kianmanesh, R. Povidone-iodine vs sodium hypochlorite enema for mechanical preparation before elective open colonic or rectal resection with primary anastomosis: a multicenter randomized controlled trial. Arch. Surg., 2006 Dec; 141 (12): 1168–1174.

64. Antolovic, D., Reissfelder, C., Koch, M. Surgical treatment of sigmoid diverticulitis – analysis of predictive risk factors for postoperative infections, surgical complications, and mortality. Int. J. Colorectal Dis., 2009 May; 24 (5): 577–584.

65. Constantinides, V. A., Aydin, H. N., Tekkis, P. P. Long-term, health-related, quality of life comparison in patients undergoing single stage vs staged resection for complicated diverticular disease. Colorectal Dis., 2006 Oct; 8 (8): 663–671.

66. Böttger, T. C., Müller, M., Terzic, A. Laparoscopic resection with primary anastomosis in Hinchey stages I and II without previous abscess drainage. Chirurg, 2007 May; 78 (5): 454, 456–460.

67. Guller, U., Jain, N., Hervey, S. Laparoscopic vs open colectomy: outcomes comparison based on large nationwide databases. Arch. Surg., 2003 Nov; 138(11): 1179–1186.

68. Bartus, C. M., Lipof, T., Sarwar, C. M., et al. Colovesical fistula: not a contraindication to elective laparoscopic colectomy. Dis. Colon Rectum, 2005 Feb; 48 (2): 233–236.

69. Weber, P. A., Merola, S., Wasielewski, A., et al. Telerobotic-assisted laparoscopic right and sigmoid colectomies for benign disease. Dis. Colon Rectum, 2002; 45: 1689.

70. Fang, J. F., Chen, R. J., Lin, B. C., et al. Aggressive resection is indicated for cecal diverticulitis. Am. J. Surg., 2003 Feb; 185 (2): 135–140.

71. de Oliveira, N. C., Welch, J. P. Giant diverticula of the colon: a clinical assessment. Am. J. Gastroenterol., 1997 Jul; 92(7): 1092–1096.

72. Collin, J. E., Atwal, G. S., Dunn, W. K., et al. Laparoscopic-assisted resection of a giant colonic diverticulum: a case report. J. Med. Case Reports, 2009 May 28; 3: 7075.

73. Iwamoto, J., Mizokami, Y., Shimokobe, K., et al. Therapeutic barium enema for bleeding colonic diverticula: four case series and review of the literature. World J. Gastroenterol., 2008 Nov 7; 14 (41): 6413–6417.

74. Alfonso, S., Pera, M., Parés, D., et al. Outpatient treatment of patients with uncomplicated acute diverticulitis. Colorectal Dis., 2009 Nov 10.

75. Mizuki, A., Nagata, H., Tatemichi, M., et al. The out-patient management of patients with acute mild-to-moderate colonic diverticulitis. Aliment Pharmacol. Ther., 2005 Apr 1; 21 (7): 889–897.

76. Constantinides, V. A., Tekkis, P. P., Athanasiou, T., et al. Primary resection with anastomosis vs. Hartmann’s procedure in nonelective surgery for acute colonic diverticulitis: a systematic review. Dis. Colon Rectum, 2006; 49: 966.

77. Germer, C. T., Buhr, H. J. Sigmoid diverticulitis. Surgical indications and timing. Chirurg, 2002 Jul; 73 (7): 681–689.

78. Köhler, L., Sauerland, S., Neugebauer, E. Diagnosis and treatment of diverticular disease: results of a consensus development conference. The Scientific Committee of the European Association for Endoscopic Surgery. Surg. Endosc., 1999 Apr; 13 (4): 430–436.

79. Chautems, R. C., 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 Jul; 45 (7): 962–966.

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

81. Wong, W. D., Wexner, S. D., et al. Practice parameters for the treatment of sigmoid diverticulitis – supporting documentation. Dis. Colon Rectum, 2000; 43: 289–297.

82. Chapman, J. R., Dozois, E. J., Wolff, B. G., et al. Diverticulitis: a progressive disease? Do multiple recurrences predict less favorable outcomes? Ann. Surg., 2006 Jun; 243 (6): 876–830; discussion 880–883.

83. Ooi, K., Wong, S. W. Management of ymptomatic colonic diverticular disease. Med. J. Aust., 2009 Jan 5; 190 (1): 37–40.

84. Ambrosetti, P., Chautems, R., Soravia, C., Peiris-Waser, N., Terrier, F. Long-term outcome of mesocolic and pelvic diverticular abscesses of the left colon: a prospective study of 73 cases. Dis. Colon Rectum, 2005; 48: 787–791.

85. Ambrosetti, P., Morel, P. Acute left-sided colonic diverticulitis: diagnosis and surgical indications after successful conservative therapy of first time acute diverticulitis. Zentralbl. Chir., 1998; 123 (12): 1382–1385.

86. Forgione, A., Leroy, J., Cahill, R. A., et al. Prospective evaluation of functional outcome after laparoscopic sigmoid colectomy. Ann. Surg., 2009 Feb; 249 (2): 218–224.

87. Scarpa, M., Pagano, D., Ruffolo, C., et al. Health-related quality of life after colonic resection for diverticular disease: long-term results. J. Gastrointest. Surg., 2009 Jan; 13 (1): 105–112. Epub 2008 Aug 27.

88. Rafferty, J., Shellito, P., Hyman, N. H., et al. Practice parameters for sigmoid diverticulitis. Dis. Colon Rectum, 2006 Jul; 49 (7): 939–944.

89. Stollman, N., Raskin, L. Diagnosis and management of diverticular disease of the colon in adults. Ad Hoc Practice Parameters Committee of the American College of Gastroenterology. Am. J. Gastroenterol., 1999; 94: 3110–3121

90. Siewert, J. R., Huber, F. T., Brune, I. B. Early elective surgery of acute diverticulitis of the colon. Chirurg, 1995 Dec; 66 (12): 1182–1189.

91. Natarajan, S., Ewings, E. L., Vega, R. J. Laparoscopic sigmoid colectomy after acute diverticulitis: when to operate? Surgery, 2004 Oct; 136 (4): 725–730.

92. Ritz, J. P., Reissfelder, C., Holmer, C., et al. Results of sigma resection in acute complicated diverticulitis : method and time of surgical intervention. Chirurg, 2008 Aug; 79 (8): 753–758.

Labels
Surgery Orthopaedics Trauma surgery
Login
Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account

#ADS_BOTTOM_SCRIPTS#