To study the possible influence of
colonic diverticula on the risk of
peritonitis of enteral (intestinal) origin in patients undergoing continuous
peritoneal dialysis, a barium enema was carried out as a pretreatment investigation in 129 consecutive patients starting
CAPD over a 9-year period. In this prospective study comprising 3103 patient months, a total of 44 (15% of all) episodes of
peritonitis with micro-organisms of enteral origin occurred in 30 of the 129 patients. The estimated probability of developing such an episode was 16% and 24%, respectively, within 1 or 2 years of treatment.
Diverticula (greater than or equal to 1) were found in 54 (42%) of all patients. In all cases the following factors: greater than or equal to 10
diverticula, diverticular size of greater than or equal to 10 mm and
diverticula in the ascending, transverse, or descending colon, significantly increased the risk of developing
peritonitis of enteral origin (P less than 0.05). Neither
diverticula in the sigmoid colon nor
diverticulitis, as assessed by radiological findings, were identified as risk factors. Enteral episodes (as defined in this study) appear to represent mainly microperformations of existing
diverticula; such episodes should probably be regarded as and handled differently from episodes due to major perforations of the colon secondary to
diverticulitis. We conclude that
diverticular disease of the non-sigmoid colon is a risk factor for
peritonitis in
CAPD.