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Diverticular Disease
C.S. Pitchumoni
Questions and Answers
1. One of the structural abnormalities of left-sided diverticulosis is:
a.Thickening of muscle wall and shortening
b.Thinning of muscle wall and lengthening
c.Circular muscle contraction in the sigmoid colon
d.Herniation of all layers of the wall of colon
Age alone is not a determinant for segmental resection
or surgical management.
3. Diverticular bleeding is best described by which one of
the following?
a.A cause of anemia in the elderly.
b.Painless and brisk.
c.Characterized by slow oozing of altered blood.
d.A contraindication for early colonoscopy.
Answer: A
Answer: B
The large majority of colonic diverticula on the left side
of the colon are pseudodiverticula, meaning that the divertic has only the mucosal layer, in contrast to right-sided
diverticula which are true diverticula with all the layers of
the bowel wall. The diverticula herniate through the bowel
wall at weak points in the circular muscle where the
main blood vessels pass to supply the colonic mucosa.
Sustained segmental contraction results in increased
intraluminal pressure leading to outpouching of the
mucosa. Hypertonicity and colonic muscular hypertrophy
probably precede diverticular formation. Intermittent
contractions divide the colonic lumen into a series of
small compartments (small bladders).
Occult bleeding and iron deficiency anemia are not features of diverticular disease. Diverticular bleed is typically sudden in onset, profuse, self-limited, and painless.
Colonoscopy after a rapid lavage in patients with suspected diverticular bleed is recommended because of the
potential for arresting the bleed.
2.A true statement with regard to diverticulitis includes all
of the following except:
a.It is a form of segmental colitis
b.It is similar to appendicitis
c.May cause colovesical fistula
d.Needs segmental resection of the sigmoid in the elderly
Answer: D
Diverticulitis is inflammation of a diverticulum occurring
as a result of gross or microscopic perforation with an
extra-luminal pericolic infection. The perforation may be
walled-off and localized. The pathogenesis is similar to
that of appendicitis. Aminosalicylic acid (5-ASA) is a
newer modality of therapy based on the concept that “segmental colitis” develops.
4. Diverticular bleeding in the older adults is characterized
by which one of the following?
a.Often coincides with diverticulitis
b.Is often life threatening and is an indication for early
surgery
c.A second episode may occur in over 25%
d.Surgery is contraindicated because of multiple comorbid conditions
Answer: C
Diverticular bleed seldom coincides with an episode of
diverticulitis. Bleeding complicates only 5% of all cases
of colonic diverticulosis. A second bleeding episode may
occur in 22–38%, and a third recurrence in up to 50% of
patients. When surgery is indicated, comorbidity is not a
deterrent; the decision should be individualized.
5.A 70-year-old patient is admitted with the history of
severe LLQ pain, fever, and leukocytosis.
An abdominal CT scan showed evidence of diverticulitis. A
previous colonoscopy 2 years ago following an episode of
diverticulitis was negative except for presence of sigmoid
C.S. Pitchumoni and T.S. Dharmarajan (eds.), Geriatric Gastroenterology,
DOI 10.1007/978-1-4419-1623-5_53, © Springer Science+Business Media, LLC 2012
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diverticula. Patient is otherwise in good health. He was
treated with IV antibiotics and IV fluids and made good
clinical improvement.
A well accepted management option at this time is:
a.Endoscopic stent placement.
b.Surgical resection of the involved segment.
c.Strict dietary precautions avoiding nuts, popcorn, and
tomatoes.
d.A diet rich in soluble fiber.
C.S. Pitchumoni
Answer: D
Colonic stent placement is an indication only when there
is a stricture prior to definitive surgery. First episode of
diverticulitis, if uncomplicated, is not an indication for
surgery. Although many clinicians advise patients to avoid
nuts and seeds in their diet, there is no scientific evidence
for their elimination in the diet. Although data is contradictory, a diet rich in soluble fiber may help prevent complications of diverticular disease.