Diverticulitis is a condition in which diverticuli in the colon rupture. The rupture results in infection in the tissues that surround the colon.
A diverticulum is a saclike protrusion in the colonic wall that develops as a result of herniation of the mucosa and submucosa through points of weakness in the muscular wall of the colon. The colonic diverticulum is a false or pulsion diverticulum-that is, it does not contain all layers of the colonic wall.
Diverticulosis indicates the presence of multiple diverticula and generally implies an absence of symptoms Diverticular disease implies any clinical state caused by diverticula, including hemorrhage, inflammation, or their complications. Diverticulitis describes the presence of an inflammatory process associated with diverticula. Its pathogenesis is attributed to genetic and environmental factors
What is diverticulosis?
The colon (large intestine) is a long tube-like structure that stores and then eliminates waste material. Pressure within the colon causes bulging pockets of tissue (sacs) that push out from the colonic walls as a person ages. A small bulging sac pushing outward from the colon wall is called a diverticulum. More than one bulging sac is referred to in the plural as diverticula. Diverticula can occur throughout the colon but are most common near the end of the left colon referred to as the sigmoid colon. The condition of having these diverticula in the colon is called diverticulosis.
A person with diverticulosis may have few or no symptoms. When a diverticulum ruptures and infection sets in around the diverticulum, the condition is called diverticulitis. An individual suffering from diverticulitis may have abdominal pain, abdominal tenderness, and fever. When bleeding originates from a diverticulum, it is called diverticular bleeding. A person who suffers the consequences of diverticulosis in the colon is referred to as having diverticular disease.
Diverticular disease is common in the Western world but is extremely rare in areas such as Asia and Africa. Diverticular disease increases with age. It is uncommon before the age of forty, and is seen in more than fifty percent of people over the age of 60 years in the United States. Whereas most patients with diverticular disease have no or few symptoms, some patients will develop bleeding, rupture and infection (diverticulitis), constipation,diarrhea, abdominal cramps, and even colonic obstruction.
How do diverticula form?
The muscular wall of the colon grows thicker with age, although the cause of this thickening is unclear. It may reflect the increasing pressures required by the colon to eliminate feces. For example, a diet low in fiber can lead to small, hard stools which are difficult to pass and which require increased pressure to pass. The lack of fiber and small stools also may allow segments of the colon to close off from the rest of the colon when the colonic muscle in the segment contracts. The pressure in these closed-off segments may become high since the increased pressure cannot dissipate to the rest of the colon. Over time, high pressures in the colon push the inner intestinal lining outward (herniation) through weak areas in the muscular walls. These pouches or sacs that develop are called diverticula.symptoms of diverticular disease?
Most patients with diverticulosis have few or no symptoms. The diverticulosis in these individuals is found incidentally during tests for other intestinal problems. Twenty percent of patients with diverticulosis will develop symptoms related to diverticulosis. The most common symptoms of diverticular disease include:
- abdominal cramping,
- constipation, and
These symptoms are related to difficulty in passing stool through the left colon, which is narrowed by diverticular disease.
More serious complications include:
- collection of pus (abscess) in the pelvis,
- colon obstruction,
- generalized infection of the abdominal cavity (bacterial peritonitis), and
- bleeding into the colon.
A diverticulum can rupture, and the bacteria within the colon can spread into the tissues surrounding the colon causing diverticulitis. Constipation or diarrhea may also occur. A collection of pus can develop around the inflamed diverticulum, leading to formation of an abscess, usually in the pelvis. On rare occasions, the inflamed diverticula can erode into the urinary bladder, causing bladder infection and passing of intestinal gas in the urine. Inflammation in the colon can also lead to colonic bowel obstruction. Infrequently, a diverticulum ruptures freely into the abdominal cavity causing a life threatening infection called peritonitis.
Diverticular bleeding occurs when the expanding diverticulum erodes into a blood vessel at the base of a diverticulum. Rectal passage of red, dark or maroon-colored blood and clots occur without any associated abdominal pain. Blood from a diverticulum of the right colon may be black in color. Bleeding may be continuous or intermittent, lasting several days.
Patients with active bleeding usually are hospitalized for monitoring. Intravenous fluids are given to support the blood pressure. Blood transfusions are necessary for those with moderate to severe blood loss. In a rare individual with brisk and severe bleeding, the blood pressure may drop, causing dizziness, shock, and loss of consciousness. In most patients, bleeding stops spontaneously and they are sent home after several days in the hospital. Patients with persistent, severe bleeding require surgical removal of the bleeding diverticula.
Once suspected, the diagnosis of diverticular disease can be confirmed by a variety of tests. Barium X-rays (barium enemas) can be performed to visualize the colon. Diverticula are seen as barium filled pouches protruding from the colon wall.
Direct visualization of the intestine can be done with flexible tubes inserted through the rectum and advanced into the colon. Either short tubes (sigmoidoscopes) or longer tubes (colonoscopes) may be used to assist in the diagnosis and to exclude other diseases that can mimic diverticular disease.
In patients suspected of having diverticular abscess causing persistent pain and fever,ultrasound and CT scan examinations of the abdomen and pelvis can be done to detect collections of pus fluid.
Medical treatment of diverticulitis/ diverticular disease?
Most patients with diverticulosis have minimal or no symptoms, and do not require any specific treatment. A high fiber diet and fiber supplements are advisable to prevent constipation and perhaps prevent the formation of more diverticula.
Patients with mild symptoms of abdominal pain due to muscular spasm in the area of the diverticula may benefit from anti-spasmodic drugs such as:
- chlordiazepoxide (Librax),
- dicyclomine (Bentyl),
- atropine, scopolamine, phenobarb (Donnatal), and
- hyoscyamine (Levsin).
Some doctors also recommend avoidance of nuts, corn, and seeds to prevent complications of diverticulosis. Whether these dietary restrictions are beneficial is uncertain.
When diverticulitis occurs, antibiotics are usually needed. Oral antibiotics are sufficient when symptoms are mild. Some examples of commonly prescribed antibiotics include:
- ciprofloxacin (Cipro),
- metronidazole (Flagyl),
- cephalexin (Keflex), and
- doxycycline (Vibramycin).
Liquid or low fiber foods are advised during acute attacks of diverticulitis. This is done to reduce the amount of material that passes through the colon, which at least theoretically, may aggravate the diverticulitis. In severe diverticulitis with high fever and pain, patients are hospitalized and given intravenous antibiotics. Surgery is needed for patients with persistent bowel obstruction or abscess not responding to antibiotics.
Surgery for diverticulitis
Diverticulitis that does not respond to medical treatment requires surgical intervention. Surgery usually involves drainage of any collections of pus and resection (surgical removal) of the segment of the colon containing the diverticuli, usually the sigmoid colon. Surgical removal of the bleeding diverticula also is necessary for those with persistent bleeding. In patients needing surgery to stop persistent bleeding,, it is important to determine exactly where the bleeding is coming from in order to guide the surgeon.
Sometimes, diverticula can erode into the adjacent urinary bladder, causing severe recurrent urine infection and passage of gas during urination. This situation also requires surgery.
Sometimes, surgery may be suggested for patients with frequent, recurrent attacks of diverticulitis leading to multiple courses of antibiotics, hospitalizations, and days lost from work. During surgery, the goal is to remove all, or almost all, of the colon containing diverticula in order to prevent future episodes of diverticulitis. There are few long-term consequences of resection of the sigmoid colon for diverticulitis, and the surgery often can be done laparoscopically, which limits post operative pain and time for recovery.
What can be done to prevent diverticular disease?
Once formed, diverticula are permanent. No treatment has been found to prevent complications of diverticular disease.
Diets high in fiber increases stool bulk and prevents constipation, and theoretically may help prevent further diverticular formation or worsening of the diverticular condition. Some doctors recommend avoiding nuts, corn, and seeds which can plug diverticular openings and cause diverticulitis. Whether avoidance of such foods is beneficial is unclear.
Patients with known diverticular disease who develop unexplained fever,chills or abdominal pain should notify their doctor because of the possibility of the complication of diverticulitis. A better understanding of the way diverticula form and become infected will hopefully lead to the discovery of more effective ways to manage these common conditions.
Many people have small pouches in the lining of the colon, or large intestine, that bulge outward through weak spots. Each pouch is called a diverticulum. Multiple pouches are called diverticula. The condition of having diverticula is called diverticulosis. About 10 percent of Americans older than 40 have diverticulosis.1 The condition becomes more common as people age. About half of all people older than 60 have diverticulosis.
Diverticula are most common in the lower portion of the large intestine, called the sigmoid colon. When the pouches become inflamed, the condition is called diverticulitis. Ten to 25 percent of people with diverticulosis get diverticulitis.3 Diverticulosis and diverticulitis together are called diverticular disease.
Breads, cereals, and beansFiber
1/2 cup of navy beans9.5 grams
1/2 cup of kidney beans8.2 grams
1/2 cup of black beans7.5 grams
Whole-grain cereal, cold
1/2 cup of All-Bran9.6 grams
3/4 cup of Total2.4 grams
3/4 cup of Post Bran Flakes5.3 grams
1 packet of whole-grain cereal, hot3.0 grams
1 whole-wheat English muffin4.4 grams
1 medium apple, with skin3.3 grams
1 medium pear, with skin4.3 grams
1/2 cup of raspberries4.0 grams
1/2 cup of stewed prunes3.8 grams
1/2 cup of winter squash2.9 grams
1 medium sweet potato with skin4.8 grams
1/2 cup of green peas4.4 grams
1 medium potato with skin3.8 grams
1/2 cup of mixed vegetables4.0 grams
1 cup of cauliflower2.5 grams
1/2 cup of spinach3.5 grams
1/2 cup of turnip greens2.5 grams
Source: U.S. Department of Agriculture and U.S. Department of Health and Human Services, Dietary Guidelines for Americans, 2005
When is surgery necessary for diverticulitis?
If symptoms of diverticulitis are frequent, or the patient does not respond to antibiotics and resting the colon, the doctor may advise surgery. The surgeon removes the affected part of the colon and joins the remaining sections. This type of surgery—called colon resection—aims to prevent complications and future diverticulitis. The doctor may also recommend surgery for complications such as a fistula or partial intestinal obstruction.
Immediate surgery may be necessary when the patient has other complications, such as perforation, a large abscess, peritonitis, complete intestinal obstruction, or severe bleeding. In these cases, two surgeries may be needed because it is not safe to rejoin the colon right away. During the first surgery, the surgeon cleans the infected abdominal cavity, removes the portion of the affected colon, and performs a temporary colostomy, creating an opening, or stoma, in the abdomen. The end of the colon is connected to the opening to allow normal eating while healing occurs. Stool is collected in a pouch attached to the stoma. In the second surgery several months later, the surgeon rejoins the ends of the colon and closes the stoma.
Points to Remember
- Diverticulosis occurs when small pouches called diverticula bulge outward through weak spots in the colon, or large intestine.
- Most people with diverticulosis never have any discomfort or symptoms.
- Diverticula form when pressure builds inside the colon wall, usually because of constipation.
- The most likely cause of diverticulosis is a low-fiber diet because it increases constipation and pressure inside the colon.
- For most people with diverticulosis, eating a high-fiber diet is the only treatment needed.
- Fiber intake can be increased by eating whole-grain breads and cereals; fruits like apples and pears; vegetables like peas, spinach, and squash; and starchy vegetables like kidney and black beans.
- Diverticulitis occurs when the pouches become inflamed and cause pain and tenderness in the lower left side of the abdomen.
- Diverticulitis can lead to bleeding; infections; small tears, called perforations; or blockages in the colon. These complications always require treatment to prevent them from progressing and causing serious illness.
- Severe cases of diverticulitis with acute pain and complications will likely require a hospital stay. When a person has complications or does not respond to medication, surgery may be necessary.
Hope through Research
The National Institute of Diabetes and Digestive and Kidney Diseases and the National Cancer Institute sponsor research programs to investigate diverticulosis and diverticulitis. Investigation continues in several areas, including:
- a possible link between diverticular disease and inflammatory bowel disease
- the management of recurrent diverticular disease
- the use of probiotics in the prevention and treatment of diverticular disease
- indications for surgery for uncomplicated diverticulitis
Cannabinoids Treat Colon Diverticulitis Symptoms and More
"Cannabinoids and the gut: New developments and emerging concepts"
Cannabis has been used to treat gastrointestinal (GI) conditions that range from enteric infections and in?ammatory conditions to disorders of motility, emesis and abdominal pain. The mechanistic basis of these treatments emerged after the discovery of Δ-tetrahydrocannabinol as the major constituent of Cannabis. Further progress was made when the receptors for Δ-tetrahydrocannabinol were identi?ed as part of an endocannabinoid system, that consists of speci?c cannabinoid receptors, endogenous ligands and their biosynthetic and degradative enzymes. Anatomical, physiological and pharmacological studies have shown that the endocannabinoid system is widely distributed throughout the gut, with regional variation and organ-speci?c actions. It is involved in the regulation of food intake, nausea and emesis, gastric secretion and gastroprotection, GI motility, ion transport, visceral sensation, intestinal in?ammation and cell proliferation in the gut. Cellular targets have been de?ned that include the enteric nervous system, epithelial and immune cells. Molecular targets of the endocannabinoid system include, in addition to the cannabinoid receptors, transient receptor potential vanilloid 1 receptors, peroxisome proliferator-activated receptor alpha receptors and the orphan G-protein coupled receptors, GPR55 and GPR119. Pharmacological agents that act on these targets have been shown in preclinical models to have therapeutic potential. Here, we discuss cannabinoid receptors and their localization in the gut, the proteins involved in
endocannabinoid synthesis and degradation and the presence of endocannabinoids in the gut in health and disease. We focus on the pharmacological actions of cannabinoids in relation to GI disorders, highlighting recent data on genetic mutations in the endocannabinoid system in GI disease.
The endocannabinoid system is an important regulatory system in the GI tract, working in the control of both digestion and host defence; the two major functions of the gut. CB mechanisms have signi?cant potential in GI disease. As the pharmacology of CB mechanisms is increasingly understood, and more selective peripherally or locally acting agents targeting CB1 and/or CB2 receptors, or for the activation of endogenous CBs, are developed, there is considerable promise for the treatment of disorders of the gut. Care will need to be taken to fully understand the actions of speci?c drugs given the disappointment following the withdrawal of rimonabant. Central actions are predictable and it will be essential for future drug development programs to screen any potential class of CB medications for psychotropic potential. With recently emerging data on genetic mutations in elements of the endocannabinoid system, some treatment approaches may have to be tailoured to speci?c subgroups of patients. That said, the potential of this system seems to warrant further investment, both in academia and industry, in order to fully develop it as a therapeutic target in the treatment of GI disorders.
"The cannabinoid CB2 receptor: a good friend in the gut"
A. A. IZZO
Endocannabinoid Research Group, Department of Experimental Pharmacology, University of Naples Federico II, Naples, Italy
AbstractMammalian tissues express the cannabinoid 1 (CB1) receptor and the cannabinoid 2 (CB2) receptor,the latter being involved in in?ammation and pain. Insomatic nerve pathways, the analgesic effects of CB2agonism are well documented. Two papers publishedin the Journal have provided evidence that CB2receptor activation inhibits visceral afferent nerveactivity in rodents. These exciting ?ndings are dis-cussed in the context of recent data highlighting theemerging role of CB2receptor as a critical target ableto counteract hypermotility in pathophysiologicalstates, gut in?ammation and possibly colon cancer.
In conclusion, convincing evidence suggests that theCB2receptor may represent an intrinsic mechanism inthe gut able to counteract hypermotility, intestinalin?ammation and possibly cell proliferation. In thecurrent issue of the Journal, CB2receptor activationwas shown to inhibit mesenteric afferent ?ring, soadding visceral pain to this growing list of regulatoryactions of this receptor. Because the CB2 receptor is upregulated in infammatory bowel conditions, CB2receptor agonists, which are devoid of the characteris-tic psychotropic CB1-mediated effects, might representattractive benecial therapeutic compounds for themanagement of gut diseases, including IBD and IBS.
The Journal of Clinical Investigation published an article in Apr. 2004 by F. Massa, et al., from the Max Planck Institute of Psychiatry in Munich, titled "The Endogenous Cannabinoid System Protects Against Colonic Inflammation," that stated:
"The major active constitutent of the plantCannabis sativa (marijuana), THC, and a variety of natural and synthetic cannabinoids have been shown to possess anti-inflammatory activities
Results indicate that the endogenous cannabinoid system represents a promising therapeutic target for the treatment of intestinal disease conditions characterized by excessive inflammatory responses."
Gut, a peer-reviewed medical journal, published a June 2001 reviewntitled "Cannabinoids and the Gastrointestinal Tract" by R. Pertwee, PhD, that found:
"Cannabinoid receptor agonists delay gastric emptying in humans as well as in rodents, and they may also inhibit human gastric acid secretion."
It is also worth noting that there have been a number of anecdotal accounts of the effective use of cannabis in the past against dysentery and cholera."
Cell and Tissue Research published an article in Oct. 2000 titled "Localization of CB1-Cannabinoid Receptor Immunoreactivity in the Porcine Enteric Nervous System" by A. Kulkarni-Narla et al., that observed:
"Cannabis has been used for centuries in the medicinal treatment of gastrointestinal disorders. "
The United Kingdom Parliament's 1998 "Science and Technology-Ninth Report" noted:"Dr. Anita Holdcroft of Hammersmith Hospital has reported the results of a placebo-controlled trial of cannabis in a patient with severe chronic pain of gastrointestinal origin
"The patient's demand for morphine was substantially lower during treatment with cannabis than during a period of placebo treatment."
Treat with Medical marijuana. Use a whole plant extract. Indica x Sativa hybrid. Suppositories, Vaporizer, Edibles, Butter, Tinctures. Try squatting when having a bowel movement.
no kinks in the colon
1. Roberts P, Abel M, Rosen L, et al: Practice parameters for sigmoid diverticulitis. The Standards Task Force American Society of Colon and Rectal Surgeons. Dis Colon Rectum. 1995, 38: 125-132.
2. Welch CE, Allen AW, Donaldson GA. An appraisal of resection of the colon for diverticulitis of the sigmoid. Ann Surg. 1953, 138: 332-343.
3. Lee YS. Diverticular disease of the large bowel in Singapore. An autopsy survey. Dis Colon Rectum. 1986, 29: 330-335.
4. Richter SJ, vd Linde J, Dominok GW. Diverticular disease. Pathology and clinical aspects based on 368 autopsy cases. Zentralbl Chir. 1991, 116: 991-998.
5. Schoetz DJ Jr. Diverticular disease of the colon: A century-old problem. Dis Colon Rectum. 1999, 42: 703-709.
6. Painter NS, Burkitt DP. Diverticular disease of the colon: A deficiency disease of Western civilization. Br Med J. 1971, 2: 450-454.
7. Acosta JA, Grebenc ML, Doberneck RC, et al: Colonic diverticular disease in patients 40 years old or younger. Am Surg. 1992, 58: 605-607.
8. Ambrosetti P, Robert JH, Witzig JA, et al: Acute left colonic diverticulitis in young patients. J Am Coll Surg. 1994, 179: 156-160.
9. Konvolinka CW. Acute diverticulitis under age forty. Am J Surg. 1994, 167: 562-565.
10. Meyers MA, Volberg F, Katzen B, et al: The angioarchitecture of colonic diverticula. Significance in bleeding diverticulosis. Radiology. 1973, 108: 249-261.
11. Meyers MA, Alonso DR, Gray GF, et al: Pathogenesis of bleeding colonic diverticulosis. Gastroenterology. 1976, 71: 577-583.
12. Wess L, Eastwood MA, Wess TJ, et al: Cross linking of collagen is increased in colonic diverticulosis. Gut. 1995, 37: 91-94.
13. Waldron DJ, Gill RC, Bowes KL. Pressure response of human colon to intraluminal distension. Dig Dis Sci. 1989, 34: 1163-1167.
14. Ford MJ, Camilleri M, Wiste JA, Hanson RB. Differences in colonic tone and phasic response to a meal in the transverse and sigmoid human colon. Gut. 1995, 37: 264-269.
15. Thomson HJ, Busuttil A, Eastwood MA, et al: The submucosa of the human colon. J Ultrastruct Mol Struct Res. 1986, 96: 22-30.
16. Thomson HJ, Busuttil A, Eastwood MA, et al: Submucosal collagen changes in the normal colon and in diverticular disease. Int J Colorectal Dis. 1987, 2: 208-213.
17. Stumpf M, Cao W, Klinge U, et al: Increased distribution of collagen type III and reduced expression of matrix metalloproteinase 1 in patients with diverticular disease. Int J Colorectal Dis. 2001, 16: 271-275.
18. Whiteway J, Morson BC. Elastosis in diverticular disease of the sigmoid colon. Gut. 1985, 26: 258-266.
19. Sandberg LB, Soskel NT, Leslie JG. Elastin structure, biosynthesis, and relation to disease states. N Engl J Med. 1981, 304: 566-579.
20. Wess L, Eastwood M, Busuttil A, et al: An association between maternal diet and colonic diverticulosis in an animal model. Gut. 1996, 39: 423-427.
21. Smith AN. Colonic muscle in diverticular disease. Clin Gastroenterol. 1986, 15: 917-935.
22. Painter NS, Truelove SC, Ardran GM, Tuckey M. Segmentation and the localization of intraluminal pressures in the human colon, with special reference to the pathogenesis of colonic diverticula. Gastroenterology. 1965, 49: 169-177.
23. Ludeman L, Warren BF, Shepherd NA. The pathology of diverticular disease. Best Pract Res Clin Gastroenterol. 2002, 16: 543-562.
24. Colcock BP, Stahmann FD. Fistulas complicating diverticular disease of the sigmoid colon. Ann Surg. 1972, 175: 838-846.
25. Pontari MA, McMillen MA, Garvey RH, Ballantyne GH. Diagnosis and treatment of enterovesical fistulae. Am Surg. 1992, 58: 258-263.
26. Woods RJ, Lavery IC, Fazio VW, et al: Internal fistulas in diverticular disease. Dis Colon Rectum. 1988, 31: 591-596.
27. Fearnhead NS, Mortensen NJ. Clinical features and differential diagnosis of diverticular disease. Best Pract Res Clin Gastroenterol. 2002, 16: 577-593.
28. Wong WD, Wexner SD, Lowry A, et al: Practice parameters for the treatment of sigmoid diverticulitis—supporting documentation. The Standards Task Force. The American Society of Colon and Rectal Surgeons. Dis Colon Rectum. 2000, 43: 290-297.
29. Padidar AM, Jeffrey RB Jr, Mindelzun RE, Dolph JF. Differentiating sigmoid diverticulitis from carcinoma on CT scans: mesenteric inflammation suggests diverticulitis. AJR Am J Roentgenol. 1994, 163: 81-83.
30. Stefansson T, Nyman R, Nilsson S, et al: Diverticulitis of the sigmoid colon. A comparison of CT, colonic enema and laparoscopy. Acta Radiol. 1997, 38: 313-319.
31. Echenique-Elizondo M, Amondarain-Arratibel JA. Barium-induced peritonitis. An infrequent but persistent picture. Gastroenterol Hepatol. 2000, 23: 25-26.
32. Schwerk WB, Schwarz S, Rothmund M. Sonography in acute colonic diverticulitis. A prospective study. Dis Colon Rectum. 1992, 35: 1077-1084.
33. Schwerk WB, Schwarz S, Rothmund M, Arnold R. Colon diverticulitis: imaging diagnosis with ultrasound—a prospective study. Z Gastroenterol. 1993, 31: 294-300.
34. Doringer E. Computerized tomography of colonic diverticulitis. Crit Rev Diagn Imaging. 1992, 33: 421-435.
35. Hulnick DH, Megibow AJ, Balthazar EJ, et al: Computed tomography in the evaluation of diverticulitis. Radiology. 1984, 152: 491-495.
36. Hulnick DH, Megibow AJ, Balthazar EJ. Diverticulitis: Evaluation by CT and contrast enema. AJR Am J Roentgenol. 1987, 149: 644-646.
37. Detry R, James J, Kartheuser A, et al: Acute localized diverticulitis: Optimum management requires accurate staging. Int J Colorectal Dis. 1992, 7: 38-42.
38. Hachigan MP, Honickman S, Eisenstat TE, et al: Computed tomography in the initial management of acute left-sided diverticulitis. Dis Colon Rectum. 1992, 35: 1123-1129.
39. Cho KC, Morehause HT, Alterman DD, Thornhill BA. Sigmoid diverticulitis: Diagnostic role of CT comparison with barium enema studies. Radiology. 1990, 176: 111-115.
40. Janes S, Meagher A, Frizelle A. Elective surgery after diverticulitis. Br J Surg. 2005, 92: 133-142.
41. Ambrosetti P, Jenny A, Becker C, et al: Acute left colonic diverticulitis—compared performance of computed tomography and water-soluble contrast enema: Prospective evaluation of 420 patients. Dis Colon Rectum. 2000, 43: 1363-1367.
42. Stollman N, Raskin JB. Diverticular disease of the colon. Lancet. 2004, 363: 631-639.
43. Ambrosetti P, Grossholz M, Becker C, et al: Computed tomography in acute left colonic diverticulitis. Br J Surg. 1997, 84: 532-534.
44. Larson DM, Masters SS, Spiro HM. Medical and surgical therapy in diverticular disease: A comparative study. Gasteroenterology. 1976, 71: 734-747.
45. Painter NS. Diverticular disease of the colon. The first of the Western diseases shown to be due to deficiency of dietary fiber. S Afr Med J. 1982, 61: 1016-1020.
46. Chapman J, Davies M, Wolff B, et al: Complicated diverticulitis: Is it time to rethink the rules?. Ann Surg. 2005, 242: 576-583.
47. Bahadursingh AM, Virgo KS, Kaminski DL, et al: Spectrum of disease and outcome of complicated diverticular disease. Am J Surg. 2003, 186: 696-701.
48. Ambrosetti P, Chautems P, Soravia C, et al: Long-term outcome of mesocolic and pelvic diverticular abscesses of the left colon: a prospective study of 73 cases. Dis Colon Rectum. 2005, 48: 787-791.
49. Deans GT, Krukowski ZH, Irwin ST. Malignant obstruction of the left colon. Br J Surg. 1994, 81: 1270-1276.
50. Hinchey EJ, Schaal PG, Richards GK. Treatment of perforated diverticular disease of the colon. Adv Surg. 1978, 12: 85-109.
51. Aydin HN, Remzi FH, Tekkis PP, et al: Hartmann's reversal is associated with high postoperative adverse events. Dis Colon Rectum. 2005, 48: 2117-2126.
52. Mueller MH, Glaetzer J, Kasparek MS, et al: Long-term outcome of conservative treatment in patients with diverticulitis of the sigmoid colon. Eur J Gastroenterol Hepatol. 2005, 17: 649-654.
53. Salem L, Veenstra DL, Sullivan SD, et al: The timing of elective colectomy in diverticulitis: A decision analysis. J Am Coll Surg. 2004, 199: 904-912.
54. Guzzo J, Hyman N. Diverticulitis in young patients: Is an aggressive approach really justified?. Dis Colon Rectum. 2004, 47: 1187-1191.
55. Schwandener O, Farke S, Fischer F, et al: Laparoscopic colectomy for recurrent and complicated diverticulitis: A prospective study of 396 patients. Langenbecks Arch Surg. 2004, 389: 97-103.
56. Guller U, Jain N, Harvey S, et al: Laparoscopic vs. open colectomy: Outcomes comparison based on large nationwide databases. Arch Surg. 2003, 138: 1179-1186.
57. Dwivedi A, Chahin F, Agrwal S, et al: Laparoscopic colectomy vs. open colectomy for sigmoid diverticular disease. Dis Colon Rectum. 2002, 45: 1309-1314.
58. Parks TG. Natural history of diverticular disease of the colon. Clin Gastroenterol. 1975, 4: 53-69.
59. Roberts PL, Veidenheimer MC. Current management of diverticulitis. Adv Surg. 1994, 27: 189-208.
60. Schauer PR, Ramos R, Ghiatas AA., et al: Virulent diverticular disease in young obese men. Am J Surg. 1992, 164: 443-446.
61. Konvolinka CW. Acute diverticulitis under age forty. Am J Surg. 1994, 167: 562-565.
62. Acosta JA, Grebenc ML, Doberneck RC, et al: Colonic diverticular disease in patients 40 years old or younger. Am Surg. 1992, 58: 605-607.
63. Ambrosetti P, Robert JH, Witzig JA, et al: Acute left colonic diverticulitis in young patients. J Am Coll Surg. 1994, 179: 156-160.
64. Biondo S, Pares D, Marti Rague J, et al: Acute colonic diverticulitis in patients under 50 years of age. Br J Surg. 2002, 89: 1137-1141.
65. Makela J, Vuolio S, Kiviniemi H, et al: Natural history of diverticular disease: When to operate? Dis Colon Rectum. 1998, 41: 1523-1528.
66. Spivak H, Weinrauch S, Harvey JC, et al: Acute colonic diverticulitis in the young. Dis Colon Rectum. 1997, 40: 570-574.
67. Tyau ES, Prystowsky JB, Joehl RJ, et al: Acute diverticulitis. A complicated problem in the immunocompromised patient. Arch Surg. 1991, 126: 855-858.
68. Perkins JD, Shield CF 3rd, Chang FC, et al: Acute diverticulitis. Comparison of treatment in immunocompromised and nonimmunocompromised patients. Am J Surg. 1984, 148: 745-748.
69. Patient Care Committee of the Society for Surgery of the Alimentary Tract (SSAT). Surgical treatment of diverticulitis. J Gastrointest Surg. 1999, 3: 212-213.
70. Thaler K, Baig MK, Berho M, et al: Determinants of recurrence after sigmoid resection for uncomplicated diverticulitis. Dis Colon Rectum. 2003, 46: 385-388.
71. Lo CY, Chu KW. Acute diverticulitis of the right colon. Am J Surg. 1996, 171: 244-246.
72. Eggimann T, Kung C, Klaiber C. Right-sided diverticulitis: New diagnostic and therapeutic aspects. Schweiz Med Wochenschr. 1997, 127: 1474-1481.
73. Markham NI, Li AK. Diverticulitis of the right colon—experience from Hong Kong. Gut. 1992, 33: 547-549.
74. Lane JS, Sarkar R, Schmit PJ, et al: Surgical approach to cecal diverticulitis. J Am Coll Surg. 1999, 188: 629-634.
75. Rafferty J, Shellito P, Hyman NH, et al: Practice parameters for sigmoid diverticulitis. Dis Colon Rectum. 2006, 49: 939-944.
1. "Diverticular disease". Umm.edu. 2008-08-29. Retrieved 2010-02-10.
2. "Diverticular Disease: Oregon Health & Science University - Portland, Oregon". Ohsu.edu. Retrieved 2010-02-10.
3. "Avoid Certain Foods To Prevent Diverticulitis - Health News Story". KNSD San Diego. Archived from the original on 2007-10-12. Retrieved 2007-11-19.
4. a b Weisberger, L; Jamieson, B (2009 Jul). "Clinical inquiries: How can you help prevent a recurrence of diverticulitis?". The Journal of family practice 58 (7): 381-2. PMID 19607778.
5. Lee, Kyoung Ho; Lee, Hye Seung; Park, Seong Ho; Bajpai, Vasundhara; Choi, Yoo Shin; Kang, Sung-Bum; Kim, Kil Joong; Kim, Young Hoon (2007). "Appendiceal Diverticulitis". Journal of Computer Assisted Tomography 31 (5): 763–9. doi:10.1097/RCT.0b013e3180340991.PMID 17895789.
6. Horton, KM; Corl, FM; Fishman, EK (2000). "CT evaluation of the colon: inflammatory disease". Radiographics : a review publication of the Radiological Society of North America, Inc 20 (2): 399–418. PMID 10715339.
7. Bogardus, Sidney T. (2006). "What Do We Know About Diverticular Disease?". Journal of Clinical Gastroenterology 40: S108–11.doi:10.1097/01.mcg.0000212603.28595.5c. PMID 16885691.
8. PMID 21523694
9. Spirt, Mitchell (2010). "Complicated Intra-abdominal Infections: A Focus on Appendicitis and Diverticulitis". Postgraduate Medicine 122 (1): 39–51.doi:10.3810/pgm.2010.01.2098. PMID 20107288.
10. Merck, Sharpe & Dohme. "Diverticulitis treatments" 2010-02-23.
11. What's the diverticulitis surgery? Digestive Disoders portal. Retrieved on 2010-02-23
12. Diverticulitis: Treatment & Medication eMedicine. 2010-02-23
13. Diverticulitis Surgery 2010-02-23
14. Gupta, Aditya K.; Chaudhry, Maria; Elewski, M (2003). "Tinea corporis, tinea cruris, tinea nigra, and piedra". Dermatologic Clinics 21 (3): 395–400, v.doi:10.1016/S0733-8635(03)00031-7. PMID 12956194.
15. Bowel resection procedure Encyclopedia of surgery. Retrieved on 2010-02-23
16. Cross, Michael J.; Snyder, Samuel K. (1993). "Laparoscopic-Directed Small Bowel Resection for Jejunal Diverticulitis With Perforation". Journal of Laparoendoscopic Surgery 3 (1): 47–9. doi:10.1089/lps.1993.3.47. PMID 8453128.
17. Diverticulitis treatments and drugs Mayo Clinic. 2010-02-23
18. Cole, C; Wolfson, A (2007). "Case Series: Diverticulitis in the Young". Journal of Emergency Medicine 33 (4): 363–6.doi:10.1016/j.jemermed.2007.02.022. PMID 17976749.