Giant diverticula, which are rare, range in diameter from 3 to 15 cm and may be single. Muscular hypertrophy is a common finding in the sigmoid. Symptoms, Signs, and Diagnosis Bleeding, sometimes massive, can occur from the lumen of a diverticulum, probably caused by erosion of the adjacent vessel secondary to impacted feces in the diverticulum. Except for bleeding, diverticula per se are harmless. However, because of fecal impaction in the sac, secondary erosion and inflammation and diverticulitis can follow with the attendant complications.
Diverticulosis is suspected when symptoms such as rectal bleeding or diverticulitis are present.
Based on this suspicion and in the absence of acute symptoms, diverticulosis can usually be diagnosed by barium enema, particularly when air-contrast is used, or by colonoscopy. If bleeding stops spontaneously or after angiography, further tests to exclude other causes of bleeding should be performed in 2 to 3 wk. Treatment Treatment of diverticulosis attempts to reduce segmental spasm. A high-roughage diet helps and may be supplemented by psyllium seed preparations or bran. Low-roughage diets are contraindicated.