Diverticular disease involves three entities:

Diverticulosis, diverticulitis and hemorrhage from diverticula.

Diverticulosis consists of the formation of saccular structures in the colon wall. These structures can be of different sizes and from minimal to large in number.

Diverticula are believed to form from increased pressure in the colon due to irritable bowel syndrome, constipation, and a hereditary component. The most common site of diverticula formation is the left colon, mainly the sigmoid.

Diverticulosis is a very common pathology, it occurs in 10% of people over 40 years of age and the frequency increases with age, affecting the majority of people over 80 years of age.

Complications of diverticulosis occur in 20% of patients. These are infection (diverticulitis) and bleeding (diverticular hemorrhage).

Diverticulitis occurs due to a microperforation of the diverticulum, which causes localized peritonitis in most cases. Diverticular hemorrhage occurs from inflammation, ulceration, and rupture of the blood vessels that supply the diverticulum.

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What are the symptoms of diverticulosis?

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Diverticulosis does not give symptoms and is only manifested by the complications that can cause.

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How is it diagnosed?

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Generally, it is a radiological finding (computed axial tomography or colon by enema) or endoscopic (colonoscopy) and since it does not give symptoms, it does not require treatment.

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How can you prevent and avoid its complications?

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Good intestinal hygiene is important to prevent diverticular disease and its complications. This hygiene can be achieved by having regular bowel movements and avoiding constipation. Adequate fiber intake is important, drink adequate amounts of water (at least 2 L) and exercise regularly.

The American Dietetic Association recommends a daily intake of 20 to 35 grams of fiber. All people, regardless of whether they have diverticula or not, should try to consume this daily amount of fiber. High-fiber foods include: whole-grain or multigrain bread, high-fiber cereals, fruits, and vegetables.

A high fiber diet helps prevent constipation by decreasing the pressure within the intestine and therefore preventing the formation of diverticula.

In addition, the daily intake of fiber helps lower blood pressure, lower cholesterol levels and improves blood sugar levels.

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What are the symptoms and how is diverticulitis treated?

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The main symptoms are severe pain in the lower left quadrant of the abdomen, fever, constipation and general malaise. Sometimes the picture can be very uncharacteristic.

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How is diverticulitis diagnosed and treated?

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When having a suggestive clinical picture, the diagnosis is confirmed with a computed axial tomography.

In the initial phases, studies that increase intracolonic pressure such as colonoscopy or colon enema should be avoided; leaving these to be performed between 6 and 8 weeks after the acute picture or for uncharacteristic cases with a diagnosis in doubt.

Treatment consists of administering broad-spectrum antibiotics, analgesics, temporarily reducing the high-fiber diet, and mild laxatives in case of constipation.

If an abscess is documented or the condition does not respond to medical treatment, surgical management will be required.

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How is hemorrhage from diverticula diagnosed and treated?

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The clinical picture is characterized by abundant and multiple evacuations of reddish-vinous blood that cause acute anemia, which forces the patient to seek medical help.

Hospitalization, intensive management is required to correct the sequelae of blood loss and confirm the diagnosis with radiological and/or endoscopic studies.

Treatment can be endoscopic if the bleeding point is found by installing hemoclips or thermal therapy; radiological embolizing the affected artery or surgical in extreme cases.

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