Diverticular disease

Diverticular disease
Diagnosis in short
Diverticulum. H&E stain.
LM	mucosa/submucosa invaginate into the musuclaris propria
Gross	outpouching - best seen after sectioning
Grossing notes	partial colectomy for diverticular disease
Site	colon - classically sigmoid, other sites
Associated Dx	diverticulitis, peritonitis, diverticular disease-associated colitis
Symptoms	usu. asymptomatic, diverticulitis presents with abdominal pain - classically left lower quadrant
Prevalence	common - especially elderly
Clin. DDx	colorectal carcinoma
Treatment	usually conservative, surgical resection (recurrent or perforating diverticulitis)

Diverticular disease, also diverticulosis, is a common disease of the colon. Inflammation of diverticula is known as diverticulitis.

General

• Very common.
• Typically seen in elderly patients - 50s and 60s.

Presentations:

• Incidental finding on imaging.
• Abdominal pain.
  • Classically left lower quadrant.
  • +/-Peritoneal signs.
• Blood per rectum.
• Large bowel obstruction.

Complications:

• Diverticulitis.
• Peformation - peritonitis.
• Diverticular-associated colitis - see below.
• Bowel obstruction - not common, may mimic malignancy.

Diverticular disease-associated colitis

Features:

• Rare.
• Definitions vary somewhat - one is: IBD-like inflammation restricted to areas with diverticular disease.
• Considerable overlap with IBD histologically - no definite histologic findings.
• Rectal biopsy may be used to differentiate from ulcerative colitis.

Gross

• Corrugated - like cardboard.
• Wall thickening (reactive).
• Usually sigmoid colon.
  • May be elsewhere, e.g. appendix.

Endoscopic image

• 

  Diverticular disease. (WC/Samir)

Microscopic

Features:

• Mucosa/submucosa invagination into the musuclaris propria (MP).
  • At the site the blood vessels supplying the mucosa and submucosa penetrate the MP.

DDx:

• Colorectal carcinoma - may cause a stricture, usually obvious on microscopy.
• Inflammatory bowel disease.

Images

• 

  Diverticular disease. (WC)

www:

• DD (wikispaces.com).

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SIGMOID COLON, SIGMOIDECTOMY:
- DIVERTICULAR DISEASE WITHOUT DIVERTICULITIS.
- NEGATIVE FOR MALIGNANCY.

 SIGMOID COLON WITH EEA DONUTS, SIGMOIDECTOMY:
- DIVERTICULAR DISEASE WITHOUT EVIDENCE OF ACTIVE DIVERTICULITIS.
- ONE BENIGN SMALL LYMPH NODE.
- NEGATIVE FOR MALIGNANCY.

Perforated

RECTO-SIGMOID, LARGE BOWEL RESECTION:
- PERFORATED DIVERTICULITIS WITH SEROSITIS AND ABSCESS FORMATION.
- SUBMUCOSAL FIBROSIS.
- ONE LYMPH NODE NEGATIVE FOR MALIGNANCY ( 0 POSITIVE / 1 ).
- NEGATIVE FOR MALIGNANCY.

SIGMOID COLON, RESECTION:
- COLONIC PERFORATION ASSOCIATED WITH FAT NECROSIS, SEROSITIS AND MICROABSCESS
  FORMATION, IN THE SETTING OF DIVERTICULAR DISEASE.
- ONE LYMPH NODE NEGATIVE FOR MALIGNANCY ( 0 POSITIVE / 1 ).
- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY.

See also

• Colon.
• Gastrointestinal pathology.
• Inflammatory bowel disease (IBD).