Original Article

International Journal of Colorectal Disease

, Volume 20, Issue 1, pp 28-32

First online:

The spectrum of segmental colitis associated with diverticulosis

  • I. E. KoutroubakisAffiliated withDepartment of Gastroenterology, University Hospital Heraklion Email author 
  • , P. AntoniouAffiliated withDepartment of Gastroenterology, University Hospital Heraklion
  • , M. TzardiAffiliated withDepartment of Pathology, University Hospital Heraklion
  • , E. A. KouroumalisAffiliated withDepartment of Gastroenterology, University Hospital Heraklion

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Abstract

Background

Segmental colitis associated with diverticulosis (SCAD) has been defined as chronic colonic inflammation surrounding diverticula with rectal sparing. Distinguishing this condition from inflammatory bowel disease may be difficult. Our aim was to evaluate the epidemiological and clinical characteristics of SCAD in our area.

Methods

Retrospective case identification with prospective follow-up was done. Patients with endoscopic findings suggestive of SCAD were enrolled. The epidemiological, clinical, and histological characteristics of these patients were analyzed.

Results

Out of 605 patients with diverticulosis, 23 cases of SCAD were identified (3.8%). Four patients had histological characteristics suggestive of ulcerative colitis, in 1 case the histology was suggestive of ischemic colitis, 6 patients had histology compatible with SCAD, and the remaining patients had either transitional mucosa or minimal lesions. Four cases were refractory to conservative treatment (mesalamine and antibiotics) and surgery was required. No cases of extension of colonic inflammation in diverticula-free areas were found.

Conclusions

Segmental colitis associated with diverticulosis is not a rare disorder. It may occur with a spectrum of clinical and histologic features and may be confused with ulcerative colitis. The majority of the cases respond to medical therapy with antibiotics and/or mesalamine, whereas few cases are refractory and need surgery. No evolution to inflammatory bowel disease was observed.

Keywords

Crohn’s disease Diverticulosis Segmental colitis Ulcerative colitis