Postmortem survey of diverticular disease of the colon. I. Diverticulosis and diverticulitis.
Authors: L E Hughes
Journal: Gut (1969)

Part I Diverticulosis and diverticulitisDiverticular disease of the colon is a common cause of morbidity among many western races, and, being especially a disease of the elderly, is becoming a problem of increasing magnitude.Abdominal symptoms are common in this age group, and in the absence of evidence of other disease, the finding of diverticula on x-ray examination is prone to lead to a diagnosis of 'diverticulitis'.The frequency with which such an association is a chance one, without causal relationship, would depend on the incidence of diverticulosis in the normal population.It is probable that the present safety of colonic surgery is the major reason for a tendency to treat diverticular disease by resection at an early stage, for there has been little work reported on the natural history of the disease when treated con- servatively to prove that routine surgical excision is justified.The work which has been reported suggests that the disease is not as inexorable in its progress to serious complications as much surgical literature implies (Bolt and Hughes, 1966; Horner, 1958).Detailed studies of the pathology of diverticular disease are also surprisingly few, considering its importance as a cause of morbidity, while very little indeed is known of its aetiology.Deficiences in knowledge of aetiology and basic pathology make rational treatment difficult.This, together with the tendency to frequent diagnosis and radical therapy, may readily lead to overtreatment.This work has been carried out to determine the incidence of diverticula and associated pathology in Queensland, to attempt to assess the relationship of diverticula to symptoms, and to seek any evidence which may throw light on the aetiology of this condition. MATERIALS AND METHODSeach of 100 consecutive colons, the first taken during winter and the second during summer.The colons in this series were fixed in the undistended state, and all personally examined 24 to 48 hours after fixation.The mesentery and associated fat was dissected from the left colon, and the bowel carefully examined from internal and external aspects for the presence of diver- ticula.In this way small diverticula 2 to 3 mm in diameter were readily found.The colon and pericolic tissues were carefully examined for signs of recent or old infection, and sections were taken from such areas for histological study.Among details routinely recorded during necropsies at this hospital are the presence or absence of gallstones, an assessment of the degree of atheroma of the aorta, and the thickness of the subcutaneous fat at the umbilicus.These details were taken from the postmortem records for correlation with the presence of diverti- cula.The clinical records of all patients were studied to determine the cause of death and the presence of coexistent disease, including hypertension, and the presence of bowel symptoms at the time of admission or as recorded in the past history.INCIDENCE AND RESULTS INCIDENCE OF DIVERTICULA IN THE COLON Diverticula were found in 90 of the 200 colons (Table I).TABLE I