Diverticulosis Outpouchings of intestinal wall Incidence: 10% of people >45 yrs 10% increase per decade of life

aetiology Pressure-induced formation Weak points of colonic mucosa Penetration of arterioles into the circular muscle layer of colon Common in Sigmoid colon Low-fibre diet causes low stool bulk thereby increase intra-colonic pressure which forces the mucosa through the muscle wall alongside the blood vessels

15-20% with DD are symptomatic Diverticular disease 15-20% with DD are symptomatic Of those with symptoms: 25% develop diverticulitis and massive bleeding F>M

Diverticulitis 1. Uncomplicated 2. Complicated Fistula …think pneumaturia/faecaluria/UTIS Perforation Obstruction/strictures Massive bleeding

Symptoms/Signs of diverticulitis LLQ abdominal pain Diarrhoea Fever Localised peritonitis Blood tests: WCC and CRP useful Consider Cr ( if CT requested)

Algorithm of assessment and management DIVERTICULITIS CT-iv and po contrast Complicated Uncomplicated Mild Hospital admission Severe ? Abs and review IV Abs Consider surgery if recurrent Percutaneous drain Surgery