Skip to main content

Current knowledge of diverticular disease of the colon

The American Journal of Digestive Diseases volume 17, pages 741–759 (1972)Cite this article

Abstract

Diverticular disease of the colon is a problem common to Western man. Abnormal thickening of the colonic muscle resulting in segments of increased intraluminal pressure appears to be the underlying pathophysiologic mechanism in the production of diverticula. Diverticulosis is usually an asymptomatic condition. Maintenance of an ideal body weight, a nutritious high residue diet, avoidance of constipation and bowel irritants and occasional use of antispasmodics with sedatives may help prevent symptoms. The complications of diverticulitis—ie, obstruction, chronic blood loss, perforation and fistula, occur in approximately one-half of patients with diverticula. Fifty percent of patients with diverticulitis have one attack responding to rest, diet, antispasmodics and antibiotics. Repeated attacks of diverticulitis may lead to other complications, and surgical management with colostomy, segmental resection or colon myotomy may become necessary.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

References

  1. Haubrich WS: Anatomy of the colon, Gastroenterology, Second edition. Edited by H Bockus. Philadelphia, WB Saunders Co, 1964, pp 596–617

    Google Scholar 

  2. Noer RJ: Hemorrhage as a complication of diverticulitis. Ann Surg 141:674–685, 1955

    PubMed  Google Scholar 

  3. Gray H: Anatomy of the human body. 26th edition. Edited by CM Goss. Philadelphia, Lea & Febiger, 1954, pp 1312–1318

    Google Scholar 

  4. Grant's Method of Anatomy, Seventh edition. Edited by JCB Grant, JV Basmajian. Baltimore, Williams & Wilkins Co, 1965, p 223

    Google Scholar 

  5. Davenport HS: Physiology of the Digestive Tract. Second edition. Chicago, Year Book Medical Publishers Inc. 1966, p 69–77

    Google Scholar 

  6. Arfwiddson S: Pathogenesis of multiple diverticula of the sigmoid colon in diverticular disease. Acta Chir Scand (Suppl) 342:1–68, 1964

    Google Scholar 

  7. Painter NS, Truelove SC: The intraluminal pressure patterns in diverticulosis of the colon. Parts I and II. Gut 5:201–213, 1964

    Google Scholar 

  8. Idem: Parts III and IV. pp 365–373

  9. Painter NS: The aetiology of diverticulosis of the colon with special reference to the action of certain drugs on the behavior of the colon. Ann R Coll Surg Engl 34:98–119, 1964

    PubMed  Google Scholar 

  10. Painter NS, Truelove SC, Ardran GM, Tuckey M: Segmentation and the localization of intraluminal pressures in the human colon, with special reference to the pathogenesis of colonic diverticula. Gastroenterology 49:169–177, 1965

    PubMed  Google Scholar 

  11. Painter NS, Truelove SC, Ardran GM, Tuckey M: Effect of morphine, prostigmine, pethidine, and probanthine on the human colon in diverticulosis studied by intraluminal pressure recording and cineradiography. Gut 6:57–63, 1965

    Google Scholar 

  12. Painter NS: Diverticular disease of the colon: a disease of Western civilization. DM June, 1970.

  13. Painter NS: Diverticulosis of the colon: fact and speculation. Am J Dig Dis 12:222–227, 1967

    PubMed  Google Scholar 

  14. Christensen J: The control of gastrointestinal movements: some old and new views. N Engl J Med 285:85–98, 1971

    PubMed  Google Scholar 

  15. Truelove SC: Movements of the large intestine. Physiol Rev 46:457–512, 1966

    PubMed  Google Scholar 

  16. Connell AM: Motor action of the large bowel, Handbook of Physiology: A Critical, Comprehensive Presentation of Physiological Knowledge and Concepts. Section 6. Alimentary Canal. Vol 4, Motility Section. Edited by CF Code. Washington DC, American Physiological Society, 1968, pp 2075–2091

    Google Scholar 

  17. Fleischner FG, Ming S, Henken EM: Revised concepts on diverticular disease of the colon. Radiology 83:859–872, 1964

    PubMed  Google Scholar 

  18. Fleischner FG: Diverticular disease of the colon: new observations and revised concepts. Gastroenterology 60:316–324, 1971

    PubMed  Google Scholar 

  19. Painter NS: Diverticular disease of the colon. Br Med J 3:475–479, 1968

    PubMed  Google Scholar 

  20. Marcus R, Watt J: The pre-diverticular state. Brit J Surg 5:676–682, 1964

    Google Scholar 

  21. Slack WW: Bowel muscle in diverticular disease. Gut 7:668–670, 1966

    PubMed  Google Scholar 

  22. Williams I: Diverticular disease of the colon without diverticula. Radiology 89:404–412, 1967

    Google Scholar 

  23. Edwards HC: Diverticula of the intestine. Ann Surg 103:230–254, 1936

    Google Scholar 

  24. Morson BC: The muscle abnormality in diverticular disease of the sigmoid colon. Brit J Radiol 36:385–392, 1963

    Google Scholar 

  25. Morson BC: The muscle abnormality in diverticular disease of the colon. Proc Roy Soc Med 9:798–800, 1963

    Google Scholar 

  26. Spriggs EI, Marxer OA: Intestinal diverticula. QJ Med 19:1–34, 1925

    Google Scholar 

  27. Spriggs EI, Marxer OA: Multiple diverticula of the colon. Lancet 1:1067–1074, 1927

    Google Scholar 

  28. Graser E: Ueber multiple falsche divertikel in der flenna sigmoidea. Munchen Med Wschr 46:721–723, 1899

    Google Scholar 

  29. Painter NS, Burkitt DP: Diverticular disease of the colon: a deficiency disease of Western civilization. Brit Med J 11:450–454, 1971

    Google Scholar 

  30. Manousos ON, Truelove SC, Lumsden K: Prevalence of colonic diverticulosis in general population of Oxford area. Br Med J 3:762–763, 1967

    PubMed  Google Scholar 

  31. Cleland JB: Incidence of diverticulosis. Br Med J 1:579, 1968

    Google Scholar 

  32. Hughes LE: Postmortem survey of diverticular disease of the colon. Gut 10:336–351, 1969

    PubMed  Google Scholar 

  33. Mayo WJ: Diverticula of the sigmoid. Ann Surg 92:739–743, 1930

    Google Scholar 

  34. Greene WW: Diverticulitis of the colon. Am J Surg 94:282–291, 1957

    PubMed  Google Scholar 

  35. Patterson CO: Diverticulitis of the colon. Gastroenterology 18:201–208, 1951

    PubMed  Google Scholar 

  36. Asch MJ: Cecal diverticulitis: report of 16 cases and review of the literature. Surgery 65:906–910, 1969

    PubMed  Google Scholar 

  37. Hurst AF, Rowlands RP: Diverticula of the colon. Guys Hosp Rep 75:462–484, 1925

    Google Scholar 

  38. Horner JL: Natural history of diverticulosis of the colon. Am J Dig Dis 3:343–350, 1958

    PubMed  Google Scholar 

  39. Carlson AJ, Hoelzel F: Relation of diet to diverticulosis of colon in rats. Gastroenterology 12:108–115, 1949

    Google Scholar 

  40. Cleave TL, Campbell GD, Painter NS: Diabetes. Coronary Thrombosis and Saccharine Disease. Second edition. Bristol, John Wright & Sons, Ltd. 1969, pp 128–135

    Google Scholar 

  41. Cleave TL, Campbell GD: Diet and diverticulosis. Br Med J 11:50–51, 1966

    Google Scholar 

  42. Painter NS: Personal communication

  43. Willard JH, Bockus HL: Clinical and therapeutic status of cases of colonic diverticulosis seen in office practice. Am J Dig Dis 3:580–585, 1936

    Google Scholar 

  44. Lumsden K, Chaudhay NA, Truelove SC: The irritable colon syndrome. Clin Radiol 14:54–63, 1963

    PubMed  Google Scholar 

  45. Almy TP: Diverticular disease of the colon: the new look (editorial). Gastroenterology 49:109–111, 1965

    Google Scholar 

  46. De La Vega JM, Gonzalez JN, Ponce de Leon A: Colonic diverticula, Gastroenterology. Second edition, Edited by H Bockus. Philadelphia, WB Saunders CO, 1964, pp 919–949

    Google Scholar 

  47. Boles RS, Jordan SM: The clinical significance of diverticulosis. Gastroenterology 35:579–582, 1958

    PubMed  Google Scholar 

  48. Fleischner FG, Ming SC: Revised concepts on diverticular disease of the colon. Radiology 84:599–609, 1965

    PubMed  Google Scholar 

  49. Berman LG, Burdich D, Heitzman ER, Prior JT: A critical reappraisal: sigmoid peridiverticulitis. Surg Gynec Obstet 127:481–491, 1968

    PubMed  Google Scholar 

  50. Botsford TW, Curtis LE: Diverticulitis coli: criteria for management for the physician and surgeon. N Engl J Med 265:618–623, 1961

    Google Scholar 

  51. Mayo CW, Blunt CP: The surgical management of the complications of diverticulitis of the large intestine: analysis of 202 cases. Surg Clin North Am 30:1005–1012, 1950

    PubMed  Google Scholar 

  52. Bacon HE, Sherman LF: Management of diverticulitis of the sigmoid colon. Am J Surg 80:3–10, 1950

    PubMed  Google Scholar 

  53. Glieson JA: Radiologic diagnosis of colonic diverticula. Br Med J 3:558–570, 1970

    Google Scholar 

  54. Sprio HM: Clinical Gastroenterology. London, Collier-MacMillan, Ltd, 1970, p 555

    Google Scholar 

  55. Hartley RC: Dangers of diverticulitis coli. Br J Surg 51:45–49, 1964

    PubMed  Google Scholar 

  56. MacLaren IF: Perforated diverticulitis. A survey of 75 cases. J R Coll Surg Edinb 3:129–144, 1957

    PubMed  Google Scholar 

  57. Marshall SF: Earlier resection in one stage for diverticulitis of the colon. Am Surg 29:337–346, 1963

    Google Scholar 

  58. Colcock BP: Surgical treatment of diverticulitis. Am J Surg 115:264–270, 1968

    PubMed  Google Scholar 

  59. Botsford TW, Bollinger RM: Diverticulitis of the colon. Surg Gynecol Obstet 128:1208–1214, 1969

    Google Scholar 

  60. Rodkey GU, Welch CE: Diverticulitis of the colon: evolution in concept and therapy. Surg Clin North Am 45:1231–1243, 1965

    PubMed  Google Scholar 

  61. Marshak RH, Janowitz HD, Paesent DH: Granulomatous colitis in association with diverticula. N Engl J Med 283:1080–1084, 1970

    PubMed  Google Scholar 

  62. Waugh JM, Walt AJ: Current trends in the surgical treatment of diverticulitis of the sigmoid colon. Surg Clin North Am 42:1267–1276, 1962

    PubMed  Google Scholar 

  63. Leigh JE, Judd ES, Waugh JM: Diverticulitis of the colon. Am J Surg 102:51–54, 1962

    Google Scholar 

  64. Bolt DE, Hughes LE: Diverticulitis: a follow-up of 100 cases. Br Med J 1:1205–1209, 1966

    Google Scholar 

  65. Smithwick RH: Surgical treatment of diverticulitis of the sigmoid. Am J Surg 99:192–205, 1960

    PubMed  Google Scholar 

  66. Prigh JI: On the pathology and behavior of acquired non-traumatic vesico-intestinal fistula. Br J Surg 51:644–657, 1964

    PubMed  Google Scholar 

  67. Ward JN, Lavengood RW, Jr, Nay HR, Draper JW: Diagnosis and treatment of colovesical fistulas. Surg Gynecol Obstet 130:1082–1090, 1970

    PubMed  Google Scholar 

  68. Taylor FW, Epstein LI: Treatment of massive diverticular hemorrhage. Arch Surg 101:457–460, 1970

    PubMed  Google Scholar 

  69. Roseh J, Gray RK, Grollman JH, Jr, Ross G, Stechel RJ, Weiner M: Selective arterial drug infusion in the treatment of acute gastrointestinal bleeding: a preliminary report. Gastroenterology 59:341–349, 1970

    PubMed  Google Scholar 

  70. Adams JT: Therapeutic barium enema for massive diverticular bleeding. Arch Surg 101:457–460, 1970

    PubMed  Google Scholar 

  71. Raskin HF, Pletickos S: Exfoliative cytology of the colon: fifteen years of lost opportunity. Cancer 28:127–130, 1971

    PubMed  Google Scholar 

  72. Ulin AW, Sokolic IH, Thompson C: Massive hemorrhage from diverticulitis of the colon. Ann Intern Med 50:1395–1406, 1959

    PubMed  Google Scholar 

  73. Knight CD: Massive hemorrhage from diverticular disease of the colon. Surgery 42:853–861, 1957

    PubMed  Google Scholar 

  74. Foster RL, Fisher RF: Colostomy as surgery treatment for massive melena secondary to diverticulitis. Am Surg 20:734–738, 1954

    PubMed  Google Scholar 

  75. Lauridsen J, Ross RP: Acute diverticulitis of the cecum: report of 14 cases and review of 153 surgical cases. Arch Surg 64:320–330, 1952

    Google Scholar 

  76. Mayo CW, Delaney LT, Jr: Colonic diverticulitis associated with carcinoma. Arch Surg 72:957–961, 1956

    Google Scholar 

  77. Rowe RJ, Killmar GH: Collective review: diverticulitis of the colon complicated by carcinoma. Internat Abstr Surg 94:1–9, 1952

    PubMed  Google Scholar 

  78. Ponka JL, Buesh BE, Fox JD: Differential diagnosis of carcinoma of the sigmoid and diverticulitis. JAMA 172:515–519, 1960

    PubMed  Google Scholar 

  79. Overhold BF: Flexible fiberoptic sigmoidoscopy: techniques and preliminary results. Cancer 28:128–136, 1971

    Google Scholar 

  80. Thomson DMP, Krupey J, Freeman SO, Gold P: The radioimmunoassay of circulating carcino-embryonic antigen of the human digestive system. Proc Natl Acad Sci USA 64:161–167, 1969

    PubMed  Google Scholar 

  81. Reilly M: Sigmoid myotomy: five-year results. Proc R Soc Med Suppl: 139–141, 1970

  82. Reilly M: Sigmoid myotomy. Proc R Soc Med 57:556–557, 1964

    Google Scholar 

  83. Idem: Br J Surg 53:859–863, 1966

    PubMed  Google Scholar 

  84. Idem: Sigmoidal myotomy for acute diverticulitis. Dis Colon Rectum 8:42–46, 1965

    Google Scholar 

  85. David O: Sigmoid myotomy with peritoneal graft. Proc R Soc Med 62:811–812, 1969

    PubMed  Google Scholar 

  86. Wagner DE, Zollinger RW: Diverticulitis of the cecum and ascending colon. Arch Surg 83:436–443, 1961

    PubMed  Google Scholar 

  87. Laufman H, Silberman WW, Poticha J: Surgical management of diverticulitis. Internat Abstr Surg 115:409–431, 1962

    Google Scholar 

  88. Byrne JJ, Kollan AC, Basset AA: Acute diverticulitis of cecum: report of five cases. JAMA 144:823–826, 1970

    Google Scholar 

  89. Kelly HA, Hurdon E: Vermiform Appendix and Its Disease. Philadelphia, WB Saunders Co, 1905

    Google Scholar 

  90. Colcock BP: Major problems in clinical surgery, Diverticular Disease of the Colon. Philadelphia, WB Saunders Co, 1971

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Medicine, University of Chicago, 950 East 59th Street, 60637, Chicago, Ill

    Phillip M. Berman MD & Joseph B. Kirsner Md, PhD

Authors
  1. Phillip M. Berman MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Joseph B. Kirsner Md, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Berman, P.M., Kirsner, J.B. Current knowledge of diverticular disease of the colon. Digest Dis Sci 17, 741–759 (1972). https://doi.org/10.1007/BF02231648

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02231648

Keywords

  • Blood Loss
  • Perforation
  • Constipation
  • Current Knowledge
  • Diverticulitis