Diverticulosis Diverticulitis

Besides causing loss of appetite and quality of life, longstanding and severe constipation can lead to diverticulosis, diverticulitis and in worst cases perforation of the large intestine with life threatening peritonitis (McConnell et al. 2003). Diverticulosis, irritable bowel syndrome and haemorrhoids are caused by chronic constipation and can lead to bleeding and anaemia. 

Diverticulosis is usually clinically asymptomatic. About 80-85% of patients with diverticulosis have no symptoms (Cheskin et al. 1990), but it is predisposing for complications such as diverticulitis, perforation, peritonitis, fistulas and even bleeding. For a clear overview presentation of diverticulosis contrast enema has been the diagnostic gold standard for many years. 

Traditionally,contrast enemahasbeen the mainstayin the evaluation of patients suspected of having diverticulosis or acute colonic diverticulitis (Fig. 3.1). 

Diverticulosis can also be diagnosed by endoscopy (Fig. 3.2) however, when diverticulits is suspected clinically, endoscopy is contraindicated. After the acute phase of inflammation, the colon should be examined to exclude a colon carcinoma. So a complete colonic evaluation should generally be performed 6-8 weeks after the resolution of a diverticulitis. In cases of inflammation, coloscopy is often incomplete and painful for the patient. The risk for perforation is also higher because of the air insufflation. 

Acute colonic diverticulitis is a common cause of acute abdominal symptoms, especially in elderly patients. In turn, diverticulitis develops in 10-25% of the population vyith diverticulosis (Roberts et al. 1995). It is, in virtually all cases, the result of a micro-perforation of a single diverticulum (Fig. 3.5). 

Sonography can diagnose diverticulosis with an accuracy of approximately 60%. Most diverticula present as echogenic protrusions in some cases they are hypoechogenic. In most cases, diverticulitis sonographically presents as peridiverticular inflammation. Often microperforations are present. The peridiverticular inflammation of the fat is primarily hyperecho-genic, and in advanced cases is hypoechogenic. 

Schreyer AG, Furst A, Agha A et al (2004) Magnetic resonance imaging based colonography for diagnosis and assessment of diverticulosis and diverticulitis. Int J Colorectal Dis 19 474-480... 

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