Diverticular disease of the colon

Diverticulosis of the colon is characterized by sac-like protrusions of the colonic mucosa through the bowel wall at points of vascular penetration and relative weakness. Although diverticulosis is often incidental, it can have clinical manifestations such as acute uncomplicated diverticulitis, diverticulitis complications including perforation, abscess, strictures or fistulas into adjacent viscera, symptomatic uncomplicated diverticular disease, segmental colitis associated with diverticulosis, and diverticular bleeding. This chapter describes the epidemiology, pathogenesis, clinical presentation, natural history, and management of these conditions. The pathogenesis of diverticular disease of the colon remains elusive but it is likely multifactorial. Several factors are postulated to play a role, including changes in connective tissue, colonic motility, alterations in enteric nerves, genetic factors, dietary fiber intake, inflammation, and the microbiome. The diagnosis of diverticular disease is multimodal and requires clinical suspicion as well as the use of endoscopy and radiographic imaging.