Diverticular disease is characterised by the development of diverticulae (sac-like protrusions) in the wall of the bowel. Typically acquired, diverticular disease may be congenital, and occurs most commonly in the sigmoid colon (95-98%); however, diverticular disease also can involve the descending, ascending, and transverse colon as well as the jejunum, ileum, and duodenum. Diverticula are herniations of the mucosa and submucosa or the entire wall thickness through the muscularis (muscular layer of the bowel) . High intraluminal pressure and a weak colonic wall may contribute to herniation, as may abnormal colonic motility, defective muscular structure, and defects in collagen consistency and ageing.

Major causative factors and risk factors that can contribute to the incidence of diverticulitis include

• Low-fibre, Western diet
• Ageing
• Obesity
• Reduced colonic motility
• Constipation
• Family history of diverticulitis

Common signs and symptoms of diverticulitis include the following:

• Acute inflammation is associated with pain (classically in the left lower quadrant), fever and often nausea and vomiting.
• Tenderness, particularly in LLQ, with possible palpable mass or fullness
• Abdomen may be distended
• Previous episodes of dull, colicky, and diffuse abdominal pain accompanied with flatulence, distention, and change in bowel habits (diverticulosis)
• Altered bowel habits including diarrhoea, increased constipation, and tenesmus
• Painless rectal bleeding due to haemorrhage from the colon.
• Urinary symptoms if bladder or ureter are irritated
• Fistulas:

o pneumaturia or recurrent urinary tract infections (colovesicular fistulas)

o faeculent vaginal discharge (fistulas with the uterus or vagina)

• Peritonitis: severe and generalized abdominal pain
• Perforation: Back or lower extremity pain