Diverticular Disease

A diverticulum is a pouch. It can develop anywhere in the digestive system, from the gullet to the stomach, the duodenum, and the small and large bowel. They are generally either present from birth (congenital) or acquired.

Pictures 3, 4, 5 and 6 show diverticula met with in the fundus of the stomach (the domed part); in pictures 7 and 8 you see a diverticulum found in the duodenum (the twelve-finger bowel). Pictures 9, 10, 12 and 13 show colonoscopic views of diverticula that have developed inside the large bowel.

Diverticula of the bowel are something met with often, particularly with age. Diverticula generally form at weak points such as the places where the blood vessels enter the bowel. Finger-like projections come out from inside the lumen of the bowel towards the outside. When we squeeze a balloon full of water, for instance, a second small balloon forms; the making of a diverticulum is something like that.

Stool that sometimes gets into a diverticulum can turn to stone and cause infection inside the diverticulum, the formation of an abscess, and bleeding. If infection develops there are complaints of abdominal pain, high fever and shivering. An abscess can form. This situation may call for treatment in hospital. Bleeding generally lasts one to three days and stops of its own accord. Sometimes there is bleeding that can only be stopped by surgery. In bleeding from a diverticulum, blood comes with the stool either bright red or the colour of morello cherry.

In pictures 1, 2 and 11 a diverticulum of the oesophagus (the gullet) is seen. These are pouches of various sizes, generally developing in the upper and middle parts of the oesophagus. They can develop when the gullet is pushed or pulled as a result of various conditions. Sometimes they grow quite large and food collects inside them; food remains can then pass into the patient’s throat after they lie down, or the food remains that have collected inside the diverticulum can go off and cause a foul smell. The diagnosis is made by endoscopic examination.