The anatomy, pathology, and some clinical features of diverticulitis of the colon

Abstract

FORMATION of diverticula in the colon is common, but no full explanation is known why they should appear, although many aetiological theories have been put forward. In this paper the relationship of the diverticula to the muscle layers and the blood-vessels of the colon will be described: the pathological complications and the presenting clinical features will also be discussed.In order to avoid misunderstanding, an arbitrary definition of diverticulosis and diverticulitis is necessary. Diverticulosis is regarded as a pathological state of the colon when diverticula protrude through the muscle-coat of the bowel-wall; diverticulitis is a condition in which inflammatory changes have occurred in and around the diverticula and symptoms are experienced by the patient.One of the earliest descriptions of a lesion that might be diverticulitis is in the 1793 edition of Mathew Baillie's Morbid Anatomy, where a condition of "schirrus of the large intestine, particularly in the sigmoid" is described. The first detailed account of diverticula of the colon is attributed to Cruveilhier, in 1849; he described small pisiform tumours, like dark-looking varices, arising between the longitudinal bands of the colon. He was the first to consider that these swellings might become inflamed, and he also noticed that fistulae between the sigmoid colon and the bladder need not necessarily be associated with cancer.Graser (1899) was the first to make any real attempt at understanding the anatomy and pathology of diverticula formation in the colon. He provided experimental evidence to show the close relation of diverticula to the blood-vessels ; he believed that an increase in pressure in the bowel was necessary, and this he attributed to constipation. Sir Arthur Keith (1910) thought that a high intracolic pressure was the primary cause, and that this was brought about by strong contractions of the taeniae, which threw the colon into circular folds; the circular muscle-coat then contracted irregularly, and the mucous membrane was forced through at weak points where the blood-vessels ran.Once the barium enema had been introduced by Abbe (1914), Case (1914) and Pfahler (1914) carried out many examinations to show where the diverticula lay along the length of the colon. In 1916 Hamilton Drummond published his classic paper, and his demonstration of the distribution of the blood-vessels around the colon has been generally accepted (Fig. 216). Besides describing diverticula emerging most frequently between the mesenteric taenia and the two anti-mesenteric taeniae, he also observed diverticula occurring between the two anti-mesenteric taeniae ; this, he suggested, might be due to an inherent muscular weakness.Spriggs and Marxer, in 1925, introduced the term 'prediverticular state' for the saw-toothed appearance of the bowel-wall that was seen on radiographs after a barium enema; they endeavoured I3 to prove that a bacteriological lesion might be responsible for this, owing to the sigmoid colon having an infective fluid residue. In 1939 Edwards co...

Diagnosis and Management of Diverticular Disease of The Colon in Adults

“…This pattern is likely related to the penetration of the small arteries supplying the colonic mucosa (the vasa recta), with relative weakness of the muscular wall at these sites allowing for herniation of the mucosa and submucosa. In Western societies, diverticula occur mainly in the distal colon, with up to 90% of patients having involvement of the sigmoid colon, and only 15% having right-sided involvement (3,5,6). This is in contrast to Asian countries, in which right-sided involvement is more prominent (7,8).…”

Imaging of Ischemia, Obstruction and Infection in the Abdomen

“…Colonic diverticula are acquired pseudo-diverticula that may result from increased intraluminal pressure and occur at weak points in the circular muscle where mucosal vasculature penetrates on the mesenteric wall 103 . They predominantly occur in the descending and sigmoid colon but can be found anywhere in the colon apart from the rectum.…”

Pathophysiological aspects of diverticular disease of colon and role of large bowel motility

“…Diverticul are usually found in the left (sigmoid, descending) colon on either mesenteric side of the antimesenteric teniae in Western countries [5] , and occur at weak points in the circular muscle layer, where the blood vessels supply the mucosa [6] , suggesting that increased intraluminal pressure might play a role in their formation. The presence of right-sided diverticula is conversely more frequently seen in Eastern populations [7] .…”