Diverticular disease of the colon

Published on May 31, 2021   40 min

A selection of talks on Gastroenterology & Nephrology

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My name is Dale Vimalachandran and I'm a consultant colorectal surgeon from the Countess of Chester in the northwest of England and today I'm going to be talking about diverticular disease of the colon.
Just to give a background to the aims of this talk, we're going to look at some definitions of diverticular disease. We're going to talk about the epidemiology and aetiology of the disease and we're also going to look at the history of diverticular disease, which is quite interesting. And then I'm going to talk about the overview of management currently. And finally, I'm going to look at some of the current debates that currently exist within diverticular disease and then give a brief summary.
First of all, let's talk about some definitions. Now, when I was a medical student and for many years to the eighties and nineties, diverticular disease was referred to as wayside houses of ill repute. And this, when you look through the history, was based on anatomists and particularly one very famous anatomist, Sir Harold Ellis, who was told this description by his professor of anatomy, a South African professor at the turn of the century. And similarly, studies and papers published throughout the sixties and seventies, when a lot of the work on diverticular disease was done, described diverticular disease as these wayside houses. However, this is not the case and diverticulum is taken from the Latin, which is diverto, which means to turn aside and icle, which means small. So diverticulum actually refers to a small turning aside.
When we talk about diverticular disease, we talk about a small out-pouching of the lining of the bowel. These are the diverticula and these occur at the points of weakness within the bowel wall. The large bowel has two muscles, a long muscle, which we call the taeniae, which runs down the length of the bowel. And a circular muscle that wraps round the circumference of the bowel. Where blood vessels enter the bowel wall, this is a point of weakness and this is where these diverticulum pouch out. We refer to them as pseudo or false diverticula as they don't contain all the three walls of the bowel, in other words the whole muscle. So they are just the inner lining and the outer lining. Very rarely we see true diverticula of all three layers and this mainly tends to be on the right side of the bowel by the caecum. But traditionally for diverticular disease we're just simply referring to these mucosal and serosal out pouchings. When we look at the taxonomy,