Diverticular disease

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

Diverticular disease
Diagnosis in short

Diverticulum. H&E stain.

LM mucosa/submucosa invaginate into the musuclaris propria
Gross outpouching - best seen after sectioning
Site colon - classically sigmoid, other sites

Associated Dx diverticulitis, peritonitis, diverticular disease-associated colitis
Symptoms usu. asymptomatic, diverticulitis presents with abdominal pain
Prevalence common - especially elderly
Clin. DDx colorectal carcinoma
Treatment usually conservative, surgical resection (recurrent or perforating diverticulitis)

General

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

Complications:

  • Diverticulitis.
  • Peformation - peritonitis.
  • Diverticular-associated colitis - see below.

Diverticular disease-associated colitis

Features:[1]

  • 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).[2]
  • Usually sigmoid colon.
    • May be elsewhere, e.g. appendix.[3]

Endoscopic image

Grossing notes

Microscopic

Features:

  • Mucosa/submucosa invagination into the musuclaris propria (MP).
    • At the site the blood vessels supplying the mucosa and submucosa penetrate the MP.[4]

DDx:

Images

www:

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SIGMOID COLON, SIGMOIDECTOMY:
- DIVERTICULAR DISEASE WITHOUT DIVERTICULITIS.
- 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

References

  1. Mulhall, AM.; Mahid, SS.; Petras, RE.; Galandiuk, S. (Jun 2009). "Diverticular disease associated with inflammatory bowel disease-like colitis: a systematic review.". Dis Colon Rectum 52 (6): 1072-9. doi:10.1007/DCR.0b013e31819ef79a. PMID 19581849.
  2. Nicholson, BD.; Hyland, R.; Rembacken, BJ.; Denyer, M.; Hull, MA.; Tolan, DJ. (Aug 2011). "Colonoscopy for colonic wall thickening at computed tomography: a worthwhile pursuit?". Surg Endosc 25 (8): 2586-91. doi:10.1007/s00464-011-1591-7. PMID 21359889.
  3. Sohn, TJ.; Chang, YS.; Kang, JH.; Kim, DH.; Lee, TS.; Han, JK.; Kim, SH.; Hong, YO. (Jan 2013). "Clinical characteristics of acute appendiceal diverticulitis.". J Korean Surg Soc 84 (1): 33-7. doi:10.4174/jkss.2013.84.1.33. PMID 23323233.
  4. West, AB.. "The pathology of diverticulitis.". J Clin Gastroenterol 42 (10): 1137-8. doi:10.1097/MCG.0b013e3181862a9f. PMID 18936652.
  5. URL: http://histology-group28.wikispaces.com/DigestiveSystemProject. Accessed on: 23 August 2011.