There are few diseases whose incidence varies as greatly worldwide as that of
diverticulosis. Its prevalence is largely age-dependent: the disease is uncommon in those under the age of 40, the prevalence of which is estimated at approximately 5%; this increases to 65% in those > or =65 years of age. Of patients with
diverticula, 80-85% remain asymptomatic, while, for unknown reasons, only three-fourths of the remaining 15-20% of patients develop symptomatic
diverticular disease. Traditional concepts regarding the causes of
colonic diverticula include alterations in colonic wall resistance, disordered colonic motility and
dietary fiber deficiency. Currently,
inflammation has been proposed to play a role in
diverticular disease. Goals of
therapy in
diverticular disease should include improvement of symptoms and prevention of recurrent attacks in symptomatic, uncomplicated
diverticular disease, and prevention of the complications of disease such as
diverticulitis.
Diverticulitis is the most usual clinical complication of
diverticular disease, affecting 10-25% of patients with
diverticula. Most patients admitted with acute
diverticulitis respond to
conservative treatment, but 15-30% require surgery. Predictive factors for severe
diverticulitis are sex,
obesity, immunodeficiency and old age. Surgery for acute complications of
diverticular disease of the sigmoid colon carries significant rates of morbidity and mortality, the latter of which occurs predominantly in cases of severe comorbidity. Postoperative mortality and morbidity are to a large extent driven by patient-related factors.