Clinical features of colonic diverticular disease N. Symeonidis • K. Psarras • M. Lalountas • M. Baltatzis • A. Micha • E. Pavlidis • A. Sakantamis Published online: 2 September 2011 Ó Springer-Verlag 2011 Abstract Colonic diverticular disease is extremely com- mon in developed countries. Although the majority of patients with diverticulosis remain asymptomatic, about one-third of the patients manifest the disease with either hemorrhage or inflammation. Diverticulitis may be uncomplicated or complicated by abscess formation, per- foration with peritonitis, fistula, intestinal obstruction, or stricture. Controversy exists regarding the aggressiveness of diverticulitis during recurrent attacks of the disease as well as in special groups of patients including immuno- compromised patients, young patients, and patients with right-sided disease. Clinical characteristics of symptomatic uncomplicated disease can be similar to irritable bowel syndrome, while acute diverticulitis is sometimes difficult to distinguish from segmental colitis associated with diverticulosis. The considerable clinical overlap between those entities with diverticular disease demonstrates that there are still areas of uncertainty in their physiopathology. Keywords Diverticular disease Á Diverticulitis Á Complications Á Recurrence Introduction Colonic diverticulosis is a frequent condition affecting the majority of aging population in Western countries. Only one-third of the patients develop symptoms, while the rest remain asymptomatic. Among those who become symp- tomatic, approximately 75% manifest the disease with uncomplicated or complicated attacks of diverticulitis and the rest with diverticular hemorrhage. Special interest is focused on uncomplicated symptomatic disease, recurrent diverticulitis, diverticulitis in young and immunocompro- mised patients, and right-sided disease. Diverticular hemorrhage More than 40% of lower gastrointestinal bleeding episodes originate from colonic diverticula [1]. Despite the fact that 90% of diverticula are located in the left colon, hemorrhage from right colon accounts for almost 50% of all bleeding episodes [2]. Diverticular bleeding generally occurs in the elderly and is rare in patients younger than the age of 50. Clinical presentation is usually of a sudden painless epi- sode and mild abdominal cramps with urge to defecate can be present. Massive hemorrhage presents in one-third of the cases, but melena is uncommon because of the arterial nature of the bleeding. Bleeding usually (70–80%) stops spontaneously, but recurs in 22–38% after the first episode and more than 50% after the second episode [3]. Diverticulitis About 75% of the patients with symptomatic DD and 10–25% of all patients with colonic diverticula will present with diverticulitis [4]. Diverticulitis arises from a process by which inflammation and focal necrosis of the divertic- ulum leads to micro- or macroperforation. Presentation greatly depends upon the location and extent of the N. Symeonidis (&) Á K. Psarras Á M. Lalountas Á M. Baltatzis Á A. Micha Á E. Pavlidis Á A. Sakantamis 2nd Propedeutical Department of Surgery, Medical School, Hippokratio General Hospital, Aristotle University of Thessaloniki, 49 Konstantinoupoleos str, PC, 54642 Thessaloniki, Greece e-mail: niksym@hotmail.com 123 Tech Coloproctol (2011) 15 (Suppl 1):S5–S8 DOI 10.1007/s10151-011-0738-9