Colonic diverticulosis

　　Most colonic diverticulosis is caused by acquired reasons, and histological studies have not found any congenital abnormalities in the muscular layer of the colonic wall. The phenomenon that the incidence of diverticula increases with age also provides strong evidence for this. Congenital colonic diverticula are rare. The etiology of diverticula needs to be clarified, and it may be the result of multiple factors working together, such as abnormal colonic smooth muscle, increased intraluminal pressure during segmental contraction, decreased compliance of the intestinal wall, and low-fiber diet.

　　Colonic diverticulosis has many complications, the common ones are mainly:
　　1. Colonic diverticulitis During acute attacks, there is varying degrees of localized abdominal pain, which can be stabbing, dull, or colicky, most of which are located in the lower left abdomen, occasionally above the pubis, lower right abdomen, or the entire lower abdomen. Inflammation adjacent to the bladder can cause frequent urination and urgency. Nausea and vomiting may also be accompanied by the location and severity of the inflammation.
　　2. Colonic diverticular hemorrhage Older patients with diverticulosis often have arteriosclerosis and vascular malformations, chemical or mechanical damage, and are prone to diverticular bleeding, which usually occurs in the right half of the colon. There are more giant or multiple diverticula and diverticulitis with bleeding.
　　3. Abscess The most common complication is the occurrence of abscess or cellulitis, which can be located in the mesentery, peritoneum, pelvis, retroperitoneum, buttocks, or scrotum. It is often palpated as a tender mass during abdominal or pelvic rectal examination, and in addition to abscesses caused by diverticula, it is accompanied by signs of varying degrees of sepsis.
　　4. Perforation After the free perforation of diverticula into the abdominal cavity, it can cause purulent or fecal peritonitis. Most of these patients present with acute abdomen and varying degrees of septic shock.
　　5. Intestinal obstruction Perforation of diverticula can cause localized inflammation and abscesses in the colon wall and around the colon, which can adhere to other parts of the intestinal tract and form an obstruction.

　　About 55% of patients with colonic diverticulosis are asymptomatic, and even with mild symptoms, they rarely seek medical attention. Common abdominal symptoms include intermittent pain in the lower abdomen, bloating, changes in bowel habits, mucous stools, tenesmus, weight loss, and decreased appetite, and anemia is not common. These symptoms may also be caused by irritable bowel syndrome that exists at the same time. Some patients may have a hiatal hernia and gallstones. Physical examination of patients usually does not show any positive findings, rectal examination is normal, and electronic colonoscopy can clearly show simple colonic diverticula.

　　Most diverticular colitis is caused by acquired factors. Histological studies have not found any congenital abnormalities in the muscular layer of the colon wall, and the phenomenon that the incidence of diverticulosis increases with age also provides strong evidence. The etiology of diverticular colitis is unknown, and there is no special preventive method.

　　The diagnosis of diverticular colitis relies not only on clinical manifestations but also on auxiliary examinations, which are indispensable. Common examinations include:
　　1. Endoscopy, barium double-contrast enema examination is helpful for diagnosis. Endoscopy should generally be avoided in acute conditions, as inflation can induce perforation or worsen existing perforation. Barium enema can be used to diagnose acute diverticulitis, but there is a risk of barium leakage into the peritoneal cavity, which can cause severe shock and death. If a rapid diagnosis is needed to guide treatment, enteroscopy with water-soluble contrast agent can be performed, so that even if there is contrast agent leakage into the peritoneal cavity, it will not cause a severe reaction.
　　2. CT scan is a non-invasive examination that can generally confirm clinical suspicions of diverticulitis. Rectal enhancement during scanning can make the detection of diverticulitis abscess or fistula more sensitive than simple X-ray contrast.
　　3. Abdominal X-ray can show colonic obstruction secondary to sigmoid colon lesions.

　　The treatment of diverticular colitis mainly involves dietary adjustments. The dietary requirements are as follows:
　　Firstly, suitable diet
　　Eat foods high in fiber; eat foods high in probiotics; eat foods rich in collagen protein.
　　Secondly, Diet taboos
　　Avoid eating hard foods; avoid eating foods with many bones and thorns; avoid eating fried foods.

　　Simple diverticular colitis usually does not cause symptoms and does not require treatment. By adjusting the diet, eating foods rich in fiber to keep the bowels smooth. Some scholars have found that a high-fiber diet not only controls the symptoms of diverticular disease but also reduces intraluminal pressure, prevents the occurrence of diverticular inflammation and bleeding, and other complications.
　　It is not very reasonable to perform a prophylactic colectomy (especially sigmoid colectomy) for patients with diverticulosis with mild symptoms. If symptoms do not improve after non-surgical treatment, or to prevent complications of diverticular disease, elective myotomy or partial colectomy can be performed.