Diverticular disease of the colon: clinical manifestations and surgical management

Abstract

Diverticular disease of the colon is a condition that affects the large intestine and can cause inflammation, infection or perforation. Treatment depends on the severity of symptoms and complications. In general, treatment includes antibiotics, painkillers, bowel rest and a low-residue diet. In more serious cases, surgery may be necessary to remove the affected part of the intestine. Surgery can be performed with primary intestinal resection or colostomy. Objective: to evaluate the clinical manifestations and surgical management of colonic diverticular disease, as well as the associated risk, prognosis and prevention factors. Methodology: followed the PRISMA checklist, the databases consulted were PubMed, Scielo, Web of Science, using the descriptors: diverticular disease, colon, clinical manifestations, surgical management and systematic review. Articles published in the last 10 years, in Portuguese or English, that addressed colon diverticular disease in adults were included. Articles that were not systematic reviews or meta-analyses, that dealt with other diseases of the large intestine or that did not present data on the clinical manifestations or surgical management of diverticular disease of the colon were excluded. Results: 15 studies were selected. The most common clinical manifestation of diverticular disease of the colon is abdominal pain in the left lower quadrant, which may be accompanied by fever, leukocytosis, changes in bowel habits and signs of peritoneal irritation. Surgery is indicated for cases refractory to conservative treatment, cases complicated by perforation, abscess, fistula or intestinal obstruction, or recurrent cases with disabling symptoms. Surgery can be performed open or laparoscopically, the latter being associated with lower morbidity and shorter hospital stays. The most commonly used surgical technique is primary intestinal resection with primary anastomosis, which consists of removing the affected part of the intestine and joining the remaining ends. In cases of diffuse peritonitis or hemodynamic instability, colostomy with deferred intestinal resection may be chosen. Conclusion: Diverticular disease of the colon is a common and potentially serious condition that requires an accurate diagnosis and appropriate treatment. Clinical manifestations range from mild symptoms to serious complications that can lead to death. Surgical management must be individualized according to the patient's clinical picture and conditions. Preventing diverticular disease of the colon involves adopting healthy lifestyle habits, such as a diet rich in fiber and practicing regular physical activity.