Diverticular Disease - A Case Study

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Diverticular Disease  - A Case Study


This case study will focus on Joan a 60 year old woman who is suspected by her General Practitioner of suffering from Diverticular Disease.  The case study will discuss the causes of Diverticular Disease and the symptoms presented and also the different diagnostic modalities used and image appearance.  The prognosis, management and treatment of the disease in Joan’s case are also considered.


There are two forms of diverticular disease. Diverticulosis indicates asymptomatic diverticular disease, and diverticulitis indicates the presence of associated inflammation (Jones 1999).  As stated in World Gastroenterology Organisation (2007) diverticular disease accounts for 75% of cases and has no complications.  Complicated diverticular disease accounts for 25% of cases and associated pathologies are abscesses, fistula, peritonitis and  sepsis.  Only a small percentage of patients with diverticulosis develop symptomatic diverticular disease.  

In this case Joan had made an appointment with her GP as she had been experiencing intermittent episodes of  abdominal pain in the left iliac fossa for over 4 weeks. The pain and bloated feeling she experienced happened normally after meal times.  She advised her doctor that the pain was coupled with a cramping sensation and alternating periods of constipation and diarrhea.  She was not experiencing any nausea or vomiting and had no weight loss or gain during this time.  As Joan has a history of follicular large cell lymphoma she is concerned that the symptoms are a return of the lymphoma.  


A diverticulum is a single sac-like pouch of mucous membrane which projects through the colon wall.  The protrusion occurs in weak areas of the bowel wall through which blood vessels can penetrate.  There are normally multiple diverticula present.  They can vary in size with a typical diameter of 5-10mm but they may reach a larger 20mm. (World Gastroenterology Organisation 2007)  Diverticula occur when an area of weakness exists in the colon wall and is accompanied by increased pressure in the lumen (Crawford 1999).   Dietary fibre intake can have an impact on lumen pressure, if there are low amounts of fibre in the diet this increases peristalsis which increases lumen pressure and results in herniation in the colon wall.  (Salzman & Lillie 2005).  

The presence of Diverticular Disease increases uniformly with age.  Approximately 50% of all people have diverticula by the time they are 50 years of age and nearly 70% of all people have diverticula by the time they are 80 years of age.  75% of people with diverticula are asymptomatic (Janes et al, 2006).  

Predisposing factors for the formation of diverticula include a low-fibre diet and physical inactivity  (Salzman & Lillie 2005). As Diverticular Disease is mostly asymptomatic  people who have it are not aware of it and it is often found when the patient is undergoing investigation for another problem.   Many symptoms experienced are similar to Irritable Bowel Syndrome.  Patients may complain of  bloating and have an area of tenderness in the left lower-abdominal quadrant.  Patients report constipation more often than diarrhea.  Stool consistency may change and become flat or ribbon-like (Meyer 2003).

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A small number of patients suffer with a perforated bowel and peritonitis and arrive in the A&E department in a shocked and distressed state. These patients present with severe

abdominal pain and a high-grade fever with nausea and vomiting (Hyde 2000).

Diverticular disease is the most common cause of lower gastrointestinal bleeding, which can occur because of the thinning of colon walls. The bleeding typically is painless, starts abruptly, and involves large volumes of blood (Kang et al 2004; Salzman & Lillie, 2005; Stollman & Raskin,1999).


Various imaging modalities can be used in ...

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