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Diverticular Disease. Diverticulosis , Diverticulitis, Meckel’s , Zenker’s. Diverticulum. Defintion Blind pouch protruding from alimentary tract that communicates with the gut lumen Most are ‘false’ Often found in sigmoid colon, can occur throughout colon

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Diverticular disease

Diverticular Disease

Diverticulosis, Diverticulitis, Meckel’s, Zenker’s


  • Defintion

    • Blind pouch protruding from alimentary tract that communicates with the gut lumen

    • Most are ‘false’

    • Often found in sigmoid colon, can occur throughout colon

  • ‘True’: all 3 gut wall layers outpouch

  • ‘False’: or ‘pseudodiverticulum’ where only mucosa and submucosaoutpouch, muscularisexterna is attenuated or non existent.


  • More common in developed countries

    • Food contains less fiber more refined carbohydrates

  • Diverticular disease (DD) less common before 40 years of age

  • >60% of people over 50 years in the US

  • Approximately 10%-25% of people with DD develop diverticulitis


  • Definition: Many diverticula

  • Caused by ↑intraluminal pressure and focal weakness in colonic wall

  • Associated with low fiber diets

  • Most often found in sigmoid colon

    • (highest intraluminal pressure!)

  • Often asymptomatic

  • Or associated with vague discomfort and/or painless rectal bleeding

Diverticular disease

The extent to which abnormal motility and hereditary factors contribute to diverticular disease is unknown.

Over time, the colon must work against greater pressures to move small, hard stools, develops hypertrophy, thickening, rigidity, and fibrosis.

Diverticular disease

Fig-- contribute to Diverticula of the sigmoid colon

Diverticular disease

Fig– Extensive contribute to diverticulosis in 77 year old female.

Diverticulitis contribute to

  • Inflammation or rupture of the diverticula

  • Classical symptoms: Lower left quadrant (LLQ) pain, fever, leukocytosis

  • Other symptoms: bright red rectal bleeding, colovesical fistula (fistula with bladder)  pneumaturia

  • May perforate  peritonitis, abscess formation or bowel stensois

  • Treatment: Antibiotics

Meckel s diverticulum
Meckel’s contribute to Diverticulum

  • Most common congential anomaly of GI tract

  • True diverticulum (3 layers outpouch)

  • Persistence of vitelline duct or yolk stalk

  • May contain ectopic acid

    • Secreting gastric mucosa and/or pancreatic tissue

  • Dx: Pertechnetate(the marker injected into the body looking for ectopic gastric tissue . This is known as a "Meckel's Scan”)

  • Can cause bleeding, intussusception, volvulus or obstruction near the terminal ileum

  • Tx: Surgical, removal of diverticulum. Complications: resection of adjacent segments

Meckel s diverticulum1
Meckel’s contribute to Diverticulum

The Five 2’s:

  • 2 inches long

  • 2 feet form ileocecalvalve

  • 2% of population

  • 2 years of life, common presentation

  • 2 types of epithelia (gastric/pancreatic)

Diverticular disease

Fig. contribute to —2-year-old girl with Meckel'sdiverticulum. Shows nuclear medicine 99mTc pertechnetate scan of child with abnormal tracer uptake in mid abdomen, just to right of midline (arrow), that was later shown at surgery to be hemorrhagic Meckel'sdiverticulum.

Zenker s diverticulum
Zenker’s contribute to Diverticulum

  • False diverticulum

  • Herniation of mucosal tissue at the junction of pharynx and esophagus

  • Symptoms: halitosis (due to trapped food), dysphagia, obstruction

  • Dx: Barium swallow. Endoscopy should not be performed due to the risk of perforating the diverticulum.

  • Tx: none for asymptomatic, surgical resection. Recently, endoscopic stapling

Diverticular disease

Fig– Barium swallow revealing contribute to Zenker’sdiverticulum