Diverticulosis and Diverticulitis

Q: 69 years old male is admitted to ICU with lower Gastrointestinal (GI) bleed causing syncope. Antibiotics should be initiated as diverticulosis and diverticulitis usually coexist.

A) True

B) False

Answer: B

Interestingly, diverticulosis and diverticulitis rarely coexist.

Diverticulitis is an inflammatory condition, while diverticulosis is a noninflammatory process. Diverticulitis occurs primarily in the left colon, whereas colonic diverticular bleeds occur mainly in right colon.

As a diverticulum herniates, the penetrating vessel responsible for the wall weakness at the point of herniation becomes draped over the dome of the diverticulum, separated from the bowel lumen only by mucosa. Over time, the vasa recta is exposed to recurrent injury along its luminal aspect, leading to the media's eccentric intimal thickening and thinning. These changes may result in segmental weakness of the artery, predisposing to rupture into the lumen. 

If diverticulitis is found to be present with diverticulosis or for both complications, bleeding and diverticulitis may be two different pathologies occurring together.

#GI

References;

1. Feuerstein JD, Falchuk KR. Diverticulosis and Diverticulitis. Mayo Clin Proc. 2016 Aug;91(8):1094-104. doi: 10.1016/j.mayocp.2016.03.012. Epub 2016 May 5. PMID: 27156370.

2. Bhatia M, Mattoo A. Diverticulosis and Diverticulitis: Epidemiology, Pathophysiology, and Current Treatment Trends. Cureus. 2023 Aug 8;15(8):e43158. doi: 10.7759/cureus.43158. PMID: 37565180; PMCID: PMC10410187.

3. Wan D, Krisko T. Diverticulosis, Diverticulitis, and Diverticular Bleeding. Clin Geriatr Med. 2021 Feb;37(1):141-154. doi: 10.1016/j.cger.2020.08.011. PMID: 33213768.