Diverticular disease

We are indebted to Professor Goligher [1] for pointing out that the word diverticulum is derived from the Latin for a wayside inn, an apt description for a cul-de-sac. Diverticula can affect any part of the gastrointestinal tract but most commonly affect the colon. Some colonic diverticula on the right side are true diverticula, which are congenital and consist of all the layers of the bowel wall. However, the usual type of diverticular disease consists of herniation of the colonic mucosa through points of weakness in the bowel wall. These areas of weakness are the points of entry of the vasa recta and appear between the taeniae coli and the mesentery. This condition is referred to as diverticulosis. If the diverticula become in ̄amed then the term diverticulitis may be used, and frequently the whole spectrum is covered by using the term diverticular disease, thus blurring the distinction between the presence or absence of in ̄ammation. Whilst this is a useful shorthand, it has tended to produce an unwillingness to differentiate between the presence or absence of in ̄ammation, which may have important therapeutic implications. The distribution of the diverticula within the colon is of interest. In the majority of cases the diverticula are con®ned to the left colon but in about a quarter of the cases the condition extends to the transverse and right colon in addition to the left colon [2]. In European countries and the USA, solitary or multiple diverticula involving the right colon are rare. In the Orient, solitary or multiple diverticula involving the right colon are two or three times more frequent than left-sided disease [3,4]. These right-sided diverticula are usually symptomless, but may develop in ̄ammation and present in a similar fashion to appendicitis.