Diverticulosis of the colon is a disease of the twentieth century. It was almost unknown before the First World War, as evidenced by the series of autopsies performed on those dates, with a rate below 5%.

The gradual increase in the prevalence of the disease has been attributed to changes in diet rich in fiber and more refined, according to epidemiological studies on Japanese born in Hawaii who switched to a Western-type diet, an increase of diverticulitis with respect to the native Japanese. This increase in prevalence, especially in Western countries, and could affect one third of the population over 45 years, since two thirds of those over 85 years, of which between 10 and 25% will develop a diverticulitis.

While it may seem obvious, it is worth recalling some definitions related to the disease. We talked about diverticulitis is present when inflammation and infection. Diverticular disease shows the broad spectrum of signs and symptoms associated with diverticulosis, ranging from discreet discomfort in the lower left quadrant of the abdomen, to the complications of diverticulitis.

Recalling briefly the pathophysiology, the formation of colonic diverticula involve two main mechanisms and an enabling factor:

Alterations in motility colic: Although some previous studies found no elevation of intraluminal pressure rather than a physiological stimulus (food) or drug (morphine or neostigmine), or only in those who complained of pain attributed to an irritable bowel syndrome, Subsequent manometric studies have shown a higher pressure in patients with diverticulosis in both basal and postprandial period in comparison to a control population or the effects of irritable colon. This hyperpressure located would be the consequence of an excessive muscle contraction, isolated segments of sigmoid "enclosed" within these segments are developed very high impulse forces favoring a herniated mucosa on the weak points of the wall which are the areas of penetration vascular, especially if associated with alterations in the intramural vascular pattern, predisposing the colon wall to vascular injury with subsequent ischemia.

Anomaly of the muscular wall of the colon: The examination of surgical specimen of colon diverticular is a thickening of the muscle layers of the intestinal wall, but the microscopic ultrastructural analysis of muscle cells has shown that the anomaly does not lie in them. The only difference lies in the people witnessing the rise of the elastin bandaletta longitudinal. This thickening of the taeniae coli could induce an excessive contraction of circular muscle, increasing the distensibility of the colic wall. This initial default is accentuated with age, explaining the increased incidence of disease in the elderly population.

Effect of the deficiency in dietary fiber: Communications epidemiological increased prevalence of diverticular disease in Western populations, the basis of the theory of fiber developed by Painter and Burkitt, connecting with a low consumption decreased fecal bolus, as well as recent publications, the weight of the stools of American media, less than 100 g/day, and the African farmer with 400 g/day, is in inverse relationship with the transit time, 77 and 35 hours respectively.

The most common complication is inflammation in the form of diverticulitis, and may include a clinic with obstruction, perforation, or fistulization to a neighboring viscus, such as evolutionary development "per se" phenomenon of parietal inflammatory intestinal or vascular continuity to the wall, in the form of bleeding.

The initial factor responsible for an inflammatory episode of diverticulitis seems to be the abduction of a Coprolite intra-diverticular, which leads to edema, erosion with a parallel increase in intra-diverticular pressure, decreased parietal blood flow and an increase in population bacteria, which together with the weakness of the diverticular sac, makes micro perforated appear, with the contamination of surrounding tissues, which in its evolution, can lead to other complications above.

Diagnosis of colonic diverticulitis

Initial clinical assessment: An initial assessment of patients with suspected diverticulitis is similar to other patients who have abdominal pain, and includes a thorough medical history and physical examination, with special emphasis on abdominal exploration. pelvic and rectal. Most patients have pain in the lower left quadrant -93% - (pain without special features for the diagnosis), fever in 57% of 69-83% and leukocytosis. Other associated symptoms include nausea, vomiting, constipation, diarrhea, dysuria and frequency, although the transverse colon diverticulitis can simulate a type of ulcer pain, and localized in the caecum or in a redundant sigmoid can clinically mimic appendicitis. There is importance of pain and persistent symptoms and the inflammatory signs (fever, leukocytosis and increased sedimentation rate) to help distinguish the spasms of colic diverticulitis. The analysis of urine may reveal pyuria and/or hematuria in patients with uncomplicated disease.

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