Segmental colitis associated with diverticulosis
- John H Pemberton, MD
John H Pemberton, MD
- Professor of Surgery
- Mayo Clinic and Mayo Medical School
Patients with diverticular disease can develop a segmental colitis most commonly in the sigmoid colon. The endoscopic and histologic features of segmental colitis associated with diverticulosis (SCAD) or diverticular colitis can range from mild inflammatory changes with submucosal hemorrhages to florid, chronic active inflammation that resembles inflammatory bowel disease [1-8].
This topic review will focus on the pathogenesis, clinical manifestations, diagnosis, and management of SCAD. The epidemiology, risk factors, and the pathogenesis of diverticulosis and diverticular disease and the clinical manifestations, diagnosis, and management of diverticulitis and diverticular bleeding are discussed in detail, separately. (See "Colonic diverticulosis and diverticular disease: Epidemiology, risk factors, and pathogenesis" and "Clinical manifestations and diagnosis of acute diverticulitis in adults" and "Acute colonic diverticulitis: Medical management" and "Colonic diverticular bleeding".)
●A diverticulum is a sac-like protrusion of the colonic wall.
●Diverticulosis is defined by the presence of diverticula. Diverticulosis may be asymptomatic or symptomatic.
●Diverticular disease is defined as clinically significant and symptomatic diverticulosis due to diverticular bleeding, diverticulitis, segmental colitis associated with diverticula, or symptomatic uncomplicated diverticular disease.
Subscribers log in hereLiterature review current through: Jul 2017. | This topic last updated: Sep 06, 2016.References
- Goldstein NS, Leon-Armin C, Mani A. Crohn's colitis-like changes in sigmoid diverticulitis specimens is usually an idiosyncratic inflammatory response to the diverticulosis rather than Crohn's colitis. Am J Surg Pathol 2000; 24:668.
- Ludeman L, Shepherd NA. What is diverticular colitis? Pathology 2002; 34:568.
- Rampton DS. Diverticular colitis: diagnosis and management. Colorectal Dis 2001; 3:149.
- Makapugay LM, Dean PJ. Diverticular disease-associated chronic colitis. Am J Surg Pathol 1996; 20:94.
- Evans JP, Cooper J, Roediger WE. Diverticular colitis - therapeutic and aetiological considerations. Colorectal Dis 2002; 4:208.
- Sladen GE, Filipe MI. Is segmental colitis a complication of diverticular disease? Dis Colon Rectum 1984; 27:513.
- Guslandi M. Segmental colitis: so what? Eur J Gastroenterol Hepatol 2003; 15:1.
- Van Rosendaal GM, Andersen MA. Segmental colitis complicating diverticular disease. Can J Gastroenterol 1996; 10:361.
- Tursi A, Elisei W, Brandimarte G, et al. The endoscopic spectrum of segmental colitis associated with diverticulosis. Colorectal Dis 2010; 12:464.
- Imperiali G, Meucci G, Alvisi C, et al. Segmental colitis associated with diverticula: a prospective study. Gruppo di Studio per le Malattie Infiammatorie Intestinali (GSMII). Am J Gastroenterol 2000; 95:1014.
- Koutroubakis IE, Antoniou P, Tzardi M, Kouroumalis EA. The spectrum of segmental colitis associated with diverticulosis. Int J Colorectal Dis 2005; 20:28.
- Mann NS, Hoda KK. Segmental colitis associated with diverticulosis: systematic evaluation of 486 cases with meta-analysis. Hepatogastroenterology 2012; 59:2119.
- Mulhall AM, Mahid SS, Petras RE, Galandiuk S. Diverticular disease associated with inflammatory bowel disease-like colitis: a systematic review. Dis Colon Rectum 2009; 52:1072.
- Tursi A, Elisei W, Giorgetti G, et al. Role of fecal calprotectin in the diagnosis and treatment of segmental colitis associated with diverticulosis. Minerva Gastroenterol Dietol 2011; 57:247.
- Tursi A. Segmental colitis associated with diverticulosis: complication of diverticular disease or autonomous entity? Dig Dis Sci 2011; 56:27.
- Pereira JM, Sirlin CB, Pinto PS, et al. Disproportionate fat stranding: a helpful CT sign in patients with acute abdominal pain. Radiographics 2004; 24:703.
- Tursi A, Elisei W, Giorgetti GM, et al. Inflammatory manifestations at colonoscopy in patients with colonic diverticular disease. Aliment Pharmacol Ther 2011; 33:358.
- Lamps LW, Knapple WL. Diverticular disease-associated segmental colitis. Clin Gastroenterol Hepatol 2007; 5:27.
- Davies NM. Toxicity of nonsteroidal anti-inflammatory drugs in the large intestine. Dis Colon Rectum 1995; 38:1311.
- Mundy L, Merlin TL, Maddern GJ, Hiller JE. Systematic review of safety and effectiveness of an artificial bowel sphincter for faecal incontinence. Br J Surg 2004; 91:665.
- Tursi A, Elisei W, Giorgetti GM, et al. Segmental colitis associated with diverticulosis: a 5-year follow-up. Int J Colorectal Dis 2012; 27:179.
- Imperiali G, Terpin MM, Meucci G, et al. Segmental colitis associated with diverticula: a 7-year follow-up study. Endoscopy 2006; 38:610.
- Hokama A, Kinjo F, Tomiyama R, et al. Progression of diverticular colitis to ulcerative colitis. Inflamm Bowel Dis 2005; 11:618.
- Peppercorn MA. Drug-responsive chronic segmental colitis associated with diverticula: a clinical syndrome in the elderly. Am J Gastroenterol 1992; 87:609.
- Tursi A, Brandimarte G, Giorgetti GM, Elisei W. Beclomethasone dipropionate plus VSL#3 for the treatment of mild to moderate diverticular colitis: an open, pilot study. J Clin Gastroenterol 2005; 39:644.