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

2. 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

3. 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

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

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

6. 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