Diverticular Disease: Complications

The following are the most important diseases or complications that may be contributed to by diverticular disease/diverticulitis:

Blood, blood-forming organs – Immune system (D50-D90).

Mouth, esophagus (food pipe), stomach, and intestines (K00-K67; K90-K93).

  • Abdominal abscess formation
  • Colonic ileus
  • Diverticular hemorrhage (= rupture of the vasa recta) – more common in diverticulosis (in 10-30% of cases) than in diverticulitis; cumulative incidence of hemorrhage is:
    • After 5 years, approximately 2%.
    • After 10 years about 10%
    • Overall incidence: 0.46 per 1,000 patient-years

    Diverticular hemorrhage is favored by hypertension (high blood pressure), nonsteroidal anti-inflammatory drugs (acetaminophen (paracetamol) and acetylsalicylic acid, ASA), and corticosteroids.[Symptoms: Hematochezia (“blood stool”), in severe cases with circulatory reaction (drop in blood pressure and increase in pulse)]

  • Diverticular perforation (rupture of a diverticulum; free or covered) – The covered perforation with abscess formation (formation of a pus cavity) is sometimes clinically indistinguishable from simple diverticulitis! It can be asymptomatic (“without symptoms”) or present with the signs of local peritonitis (localized peritonitis). Free perforation is a very rare event. It occurs predominantly in patients with asymptomatic diverticulosis to date (lethality/mortality is approximately 50%).
  • Diverticulitic stenosis (narrowing) – as a result of recurrent diverticulitis, most commonly in the sigmoid colon (→ inflammatory tumor (due to scarring shrinkage and fibrosis) leading to stenosis of the intestinal lumen (sigmoid stenosis) → recurrent subileus (later a complete colonic ileus/obstruction of the bowel) Cave! Often such a diverticulitic tumor in the lower abdomen can already be palpated.
  • Fistula formation (between individual intestinal segments, intestine and urogenital tract, and between intestine and skin) [frequency approx. 6-10%].
  • Constipation (constipation)
  • Peritonitis (inflammation of the peritoneum)
  • Recurrent diverticulitis

Neoplasms – tumor diseases (C00-D48)

  • Colon carcinoma (colon cancer) (86% higher incidence (frequency of new cases) among diverticulitis patients; after adjustment for other influences (eg, inflammatory bowel disease): odds ratio 2.2); resection (surgical removal) of the affected portion of the bowel reduced cancer risk: resected patients versus patients without surgical resection (1.9% versus 3.9%)

Prognostic factors

  • Immunosuppression – numerous studies indicate a severe course of diverticular disease in patients under immunosuppression
  • Patients with history of allergic predisposition to grasses, pollen, foods, medications, and pets – are more likely to present with complicated diverticulitis at surgery