Historical Perspectives and the Spectrum of Diverticular Disease

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CME Learning Objectives:On completion of this educational activity, learners should be better able to: (1) Recognize the various clinical presentations of the diverticular disease process, and appreciate the clinical significance it has in our society. (2). Classify patients with diverticular disease based on multiple factors including localization, clinical symptoms, presentation, and pathology.Diverticular disease of the colon is frequently termed as a “disease of the 20th century.” This entity results in a significant health burden for our society, and a recent report by the American Gastroenterology Association showed the burden of diverticular disease is estimated at $2.66 billion annually. Diverticular disease may lead to significant problems once symptomatic, but the majority of people with this condition will see no sequelae (80%). Classification of patients with diverticular disease is done with regard to multiple factors including localization, clinical symptoms, presentation, and pathology. There are 2 classification systems of importance: the clinical classification and the Hinchey classification. Asymptomatic diverticular disease is often documented on screening colonoscopy, and accounts for the majority of patients with diverticular disease. There is no clear role for treatment or follow-up. Symptomatic uncomplicated diverticular disease is often brought to the attention of the clinician because of the nonspecific abdominal symptoms. Patients may complain of left-sided lower abdominal pain without leukocytosis, fever, or peritoneal signs. They may have other complaints often associated with irritable bowel syndrome including bloating, constipation, and diarrhea. Diverticular disease may become “complicated” in a small but significant proportion of patients (10% to 25%). Complicated diverticular disease may present with obstruction, bleeding, peritonitis, free perforation, fistula, or abscess formation. Fever and leukocytosis may be seen, but there are few other helpful laboratory tests in this situation. Physical examination may show localized tenderness in the left lower quadrant, and possibly guarding or rebound depending on the severity of disease.

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