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Since the initial description of the diverticulosis of the colon in mid-1800, these saccular protrusions of the mucosa and submucosa of the colon through the bowel wall have progressively assumed more clinical importance over the 20th century and has become a common gastroenterological problem in the aging population.

Epidemiology: The prevalence is estimated at 80% in people aged over 80 (1). Men and women are equally affected. Seventy percent are asymptomatic. Approximately 25-30 % develop diverticulitis. Diverticulosis of the left colon (sigmoid and descending ) is most commonly encountered in the Western countries with low fibre intake. Diverticulosis is rarely seen in the right colon (Ascending) in some Asian countries with high fibre intake. Symptomatic presentation rapidly increases with aging.
Pathogenesis: Diverticulosis are false diverticulae created by herniation of colonic mucosa and submucosa through muscle layers of the colonic wall as a result of increased intraluminal pressure created by hypersegmentation which is believed to be the result of low fibre intake.
Diagnosis
History: Classically, a pain in the left iliac fossa and a change in bowel habit such as episodic diarrhoea and or constipation are reported. Patients often describe pas- sage of stool like pebbles. Some patients present with history of bleeding from the bowel. Not uncommonly bloating, belching and discomfort half an hour to an hour after meals is all that is described. Dysuria is an uncommon symptom.

Examination: Tenderness in the left iliac fossa and the suprapubic region is the most common finding. Masses are rarely felt in cases of diverticular inflammatory process. Febrile illness is rare even with complicated diverticulitis.
Laboratory: Blood tests are often normal. White cell may be elevated with complicated diverticulitis.
Radiology: CT scan demonstrate severe diverticulosis with bowel wall thickening and any associated abscess etc. CT is not very sensitive for mild to moderate diverticulosis without complications.
Colonoscopy: Should, preferably, be performed 4-6 weeks after treatment to determine the extent of disease and to exclude inflammatory bowel disease and neoplasia.
Complicated diverticulosis: Seventy five percent present with uncomplicated diverticulitis and respond to conservative measures. However, some 25% are com- plicated by ulceration, diverticular disease associated colitis, bleeding, abscess, perforation , fistulae and stricture formation.

Treatment

Uncomplicated diverticulitis: These patients respond to bowel rest with clear fluids orally, oral or i.v. antibiotics such as a combination of ampicillin and metronidazole for 7-14 days. Clearly these patients can be treated as out patients. Complicated diverticulitis: Having established the complicated nature such as abscess with a CT scan, conservative treatment e.g.,i.v. hydration, antibiotics and bowel rest is embarked upon. Surgical resection is considered if an earlier radiolog- ical drainage procedure for the abscess has failed. These patients require inpatient management for monitoring and may settle with conservative measures combined with radiological drainage procedure.