Diverticulosis K57.30

Diverticulosis refers to the occurrence of multiple diverticula in the colon. Diverticulitis describes the inflammation of a diverticulum in the colon.

A distinction is made between sigma and coecum diverticula.

Sigmoid diverticula are the most frequently occurring diverticula (2/3 of all cases). These are pseudodiverticula with protrusions of the intestinal mucosa through vascular gaps in the intestinal wall. The causes are high internal intestinal pressure due to constipation, for example, and a connective tissue weakness that increases with age.

Coecum diverticula mostly occur in Japan and are true diverticula with protrusions on the entire intestinal wall.

In addition, a diverticular disease is classified by clinic and CT:

• St. 0: asymptomatic diverticulitis
• St. I: Acute uncomplicated diverticulitis
• St. II: Acute complicated diverticulitis
• St III: Chronic recurrent diverticulitis

Diverticulosis is one of the diseases of civilisation in the industrialised countries that occur in the context of a diet that is too low in fibre. The disease is rare in Asia and Africa. The prevalence of diverticulosis is

• within the scope of screening colonoscopy with 28-43 %,
• within the barium contrast enema with 45
• and
• in autopsy studies, 43%.

Their prevalence increases with age: in people aged 70 and over, their prevalence is around 60%.

Sigmoid diverticulitis is characterized by spontaneous pain and a painful urge to defecate and urinate. In addition, constipation, diarrhoea and flatulence as well as a painful roll in the upper abdomen can occur.

Coecum diverticulitis is characterized by pain in the right middle and lower abdomen.

Leukocytosis, BSG and CRP may be elevated, but may also be within the normal range.

Diverticulosis usually occurs as a secondary finding during a colonoscopy.

To diagnose diverticulitis, the patient's medical history, clinical history, sonography, CT and MRT are taken, and if necessary, a general view of the abdomen is recommended.

Differential diagnoses include irritable bowel syndrome, colon carcinoma, gynaecological diseases and other chronic intestinal diseases (CED).

An initially asymptomatic diverticulosis can develop into a symptomatic diverticulitis due to inflammation and congestion of the bowel movements. A peridiverticultis is an inflammation, if it is limited to the diverticulum, the intestine is also affected, this is called pericolitis.
Other possible complications are fistulas, bleeding, free perforations and covered perforations with a Douglas abscess or pericolic abscess.

For the treatment of diverticulosis, a diet rich in fibre and ballast, exercise, sufficient fluid intake and regulation of bowel movements are recommended.

The therapy of diverticulitis includes a conservative and a surgical approach.
The conservative therapy depends on the severity of the diverticulitis. In a mild form, treatment is usually carried out on an outpatient basis and includes broad-spectrum antibiotics, medication against cramp-like pain and a low-slag, low-molecular-weight diet. If the form of diverticulitis is highly acute, in-patient treatment is carried out with broad-spectrum antibiotics, close monitoring including imaging examinations and a dietary restriction with intravenous food. Surgery is used in urgent cases and in case of recurrent diverticulitis.