• Diverticulosis refers to the presence of diverticula without inflammation.
  • Diverticular disease is a clinical term used to describe the presence of symptomatic diverticula
  • False diverticula (mucosa and muscularis mucosa have herniated through thecolonic wall) between the teniae coli, atvpoints where the main blood vessels penetrate the colonic wall
  • True diverticula, which comprise all layers of the bowel wall, are rare and are usually congenital in origin
  • The sigmoid colon is the most common site of diverticulosis
  • But in South-East Asia, right-sided diverticular disease is more common 


  • Diverticulitis: Refers to inflammation and infection associated with diverticula. Left sided lower abdominal pain, loose stools, low grade fever, tenderness and sometimes mass palpablee in the left iliac fossa (left sided appendicitis)
  • Perforation: most often contained leading to pericolic abscess formation
  • Peritonitis, Intestinal obstruction, Haemorrhage
  • Fistula formation: Colovesical fistulas are most common 

Hinchey classification of complicated diverticulitis

  • Grade I: Mesenteric or pericolic abscess
  • Grade II: Pelvic abscess
  • Grade   Purulent peritonitis
  • Grade IV: Faecal peritonitis 


  • High-fibre diet and bulk-forming laxatives
  • Acute diverticulitis is treated by intravenous antibiotics
  • Abscess < 5 cm – likely to settle with antibiotics; > 5cm – likely to require intervention. 

Urgent or emergent laparotomy

  • Abscess is inaccessible to percutaneous drainage
  • Patient’s condition deteriorates or fails to improve
  • Patient presents with free intra-abdominal air
  • Peritonitis
  • Hartmann’s procedure – safest option in emergency surgery
  • Primary anastomosis – for young and fit patiients without gross contamination or overwhelming sepsis
  • Elective resection: Recurrent attacks, Fistulae

Exam Question

  • Colonic diverticulosis is best diagnosed by Barium enema.
  • The commonest site of diverticulosis is Sigmoid Colon.
  • A patient complains to his physician of chronic constipation. On the instruction of his physician, the patient increases his dietary fiber, but his constipation persists. The physician refers the patient to a gastroenterologist. Colonoscopy reveals over fifty 2-3 mm openings into the bowel mucosa. No bleeding is seen, and the intervening mucosa appears normal. Diverticulosis is the most likely diagnosis.
  • Protrusion of mucosa through muscular layers at point of blood vessel is seen in Diverticulosis..
  • Massive bleeding per rectum in a 70 yr old patient is due to Diverticulosis.
Don’t Forget to Solve all the previous Year Question asked on Diverticulosis

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