Diverticular diseases involve pouches forming in the colon wall. Diverticulosis is common, affecting around 15-20% of people over 50. Diverticulitis is an inflammation and infection of the diverticula that can cause complications like abscesses, fistulas, or intestinal rupture. Risk factors include age over 50, low-fiber diet, obesity, and family history. Symptoms vary depending on the location of the diverticula but often include left lower quadrant pain, changes in bowel habits, and tenderness upon examination. Treatment involves antibiotics for diverticulitis flares and sometimes surgery for complications or recurrent issues.

1. Diverticular Diseases

2. • Diverticulosis is a condition that develops when
pouches form in the wall of the colon.
• False and true
• The most known true is Meckel's
Meckel's diverticulum: The rule of 2's
• 2% of the population.
• 2 feet of the ileocecal valve.
• 2 inches in length.
• presentation before the age of two.

3. • Wall layers of the intestine
• Natural opening of the vasa recta
• Mucosa and submucosa
• Anywhere but sigmoid most common
• Sigmoid “left” → pressure
• Right colon is common in Asian usually true and in general is rare
• The etiology of diverticulosis is inconclusive
• Diverticulitis Etiology is not clear
• Inflammation >>> bacterial growth >> distention >>> compromised blood supply >>
perforation (macro OR micro) >>> peritonitis and other complications
• Fistula formation (colovesical is common in males and colouterus in females )
• Uncommonly (in females) colocutaneous and colovaginal

4. • Less than 5% before the age of 40
• Increased incidence with the number of diverticulosis (15-20%)
• Only 20% younger than 50 years
• Industrial countries >>> lifestyle
• Asian countries adopted this lifestyle
• Coexisting conditions
• Younger patients
• Immunosuppressed
• Complication
• Abscess
• Fistula
• Intestinal rupture
• Peritonitis

5. Symptoms according to location of the affected diverticulum
• Left lower quadrant pain 70%
• Pain is crampy and associated with changed bowel habit
• Other symptoms:
• Nausea and Vomiting.
• Constipation.
• Diarrhea.
• Flatulence.
• Bloating.
• Asymptomatic
• Mimic acute appendicitis if lower right quadrant
Signs revealed on physical examination:
• Localized abdominal tenderness
• Tender palpable mass
• Abdomen may be distended
• Unremarkable signs in patient on Corticosteroids

6. • 17-40% of lower GI bleeding (most common cause)
• Most is self-limited in 80%
• Lactated Ringer
• Packed RBCs
• In severe bleeding → resuscitative measures
• Bowel preparation → Colonoscopy
• Endoscopic therapeutic measures for lesion detected by colonoscopy
• Epinephrine or electrocautery treatment
• Endoclips or band ligation
• For lesion not detected by Colonoscopy
• Radionuclide imaging
• Arteriography
• Treatment modalities
• Embolization (effectively controls hemorrhage in 76% to 100%)
• Injection vasopressin (seldom used clinically because rebleeding rate is
50%)

7. • Surgery
• Directed segmental resection
• Subtotal colectomy
• uncontrolled, massive, nonlocalized lower GI bleeding
refractory to other interventions
• In patients with 2 or more episodes of diverticular
hemorrhage, elective resection should be considered