Diverticular Disease: UNI-MED SCIENCE

1. Introduction 14 1.1. Definitions 14 1.2. Clinical and economic importance 14 1.3. References 15 2. Epidemiology, natural course, prognosis 18 2.1. Historical outline 18 2.2. Epidemiology 19 2.2.1. Older studies 19 2.2.2. Current studies 20 2.3. Risk factors 22 2.3.1. Diet and life-style 22 2.3.2. Genetics 25 2.4. Natural course 25 2.4.1. Recurrent (chronic) diverticulitis 25 2.4.2. Young patients 27 2.4.3. Immunosuppressed patients 27 2.4.4. Right-sided diverticulitis 27 2.4.5. Risk of polyps and colonic carcinoma in diverticulosis and diverticulitis 27 2.4.6. Diverticular bleeding 28 2.5. References 28 3. Pathogenesis of diverticular disease 34 3.1. Definition of a diverticulum 34 3.2. Anatomical and functional features of the wall of the colon 34 3.3. Histopathological features of colonic diverticula 35 3.4. Pathogenetic theories of diverticular disease 35 3.5. Influence of age 36 3.6. Influence of diet 36 3.7. Connective tissue and muscle changes in the bowel wall 36 3.8. Influence of genetic factors 37 3.9. Disorders of intestinal motility 37 3.10. Disorders of intestinal innervation 38 3.11. Aetiology of symptoms in diverticular disease 39 3.12. References 39 4. Clinical picture, diagnosis, differential diagnosis and comorbidity 44 4.1. Pathogenesis 44 4.2. Clinical picture and diagnostic investigations 45 4.2.1. Specific differential diagnoses, special courses 51 4.2.2. Imaging procedures 53 4.2.3. Diverticulitis and carcinoma 56 4.3. Complications 57 4.4. Comorbidity 57 4.5. References 57 5. Conservative therapy 62 5.1. Prevention of complications - lifestyle measures 62 5.2. Fasting 62 5.3. Antibiotics 62 5.4. Aminosalicylates 63 5.5. Probiotics 64 5.6. Analgesics 65 5.7. Conservative treatment recommendations 65 5.7.1. Therapy of uncomplicated acute diverticulitis 65 5.7.2. Therapy of complicated acute diverticular disease 65 5.7.3. Therapy of recurrent diverticulitis 66 5.8. References 66 6. Surgical treatment of diverticular disease 70 6.1. Indication for elective sigmoid resection 70 6.2. Operative technique 72 6.2.1. Operative approach 72 6.2.2. Extent of the resection 72 6.2.3. Mobilisation of the splenic flexure if required or as a matter of principle? 73 6.2.4. Central ligation or tubular resection? 73 6.2.5. Stapled anastomosis or manual suturing? 73 6.3. Perioperative management 74 6.4. Results of surgical therapy 74 6.4.1. Complications 74 6.4.2. Quality of life 74 6.4.3. Recurrences/long-term results 74 6.5. References 74 7. Management of complications 78 7.1. Background 78 7.2. Bleeding 78 7.3. Perforation and abscess 79 7.4. Treatment of complicated diverticulitis (abscess and peritonitis) 79 7.5. Fistula formation and extraperitoneal manifestations of complicated diverticulitis 81 7.6. Obstruction 82 7.7. References 83 Index 86