Segmental colitis associated diverticulosis syndrome

Abstract

Segmental colitis associated diverticulosis (SCAD) has become increasingly appreciated as a form of inflammatory disease of the colon. Several features suggest that SCAD is a distinct disorder. SCAD tends to develop almost exclusively in older adults, predominately, but not exclusively, males. The inflammatory process occurs mainly in the sigmoid colon, and usually remains localized to this region of the colon alone. SCAD most often presents with rectal bleeding and subsequent endoscopic visualization reveals a well localized process with non-specific histopathologic inflammatory changes. Granulomas are not seen, and if present, may be helpful in definition of other disorders such as Crohn’s disease of the colon, an entity often confused with SCAD. Bacteriologic and parasitic studies for an infectious agent are negative. Normal rectal mucosa (i.e., “rectal sparing”) is present and can be confirmed with normal rectal biopsies. SCAD often resolves spontaneously without treatment, or completely after a limited course of therapy with only a 5-aminosalicylate. Recurrent episodes may occur, but most often, patients with this disorder have an entirely self-limited clinical course. Occasionally, treatment with other agents, including corticosteroids, or surgical resection has been required.

Diverticular Disease: An Update on Pathogenesis and Management

“…It is characterized by nonspecific segmental inflammation in the sigmoid colon surrounded by multiple diverticula. 10 It does not necessarily involve the diverticular orifice. 11 Risk factors include male sex and age over 50 years.…”

“… 11 Risk factors include male sex and age over 50 years. 10 Initial presentation is often rectal bleeding with some presenting with diarrhea and/or abdominal pain. 10 Freeman 12 studied the clinical behavior of SCAD in over a 20-year period and noted that all patients had complete clinical and pathological remission of disease even those not treated with oral 5-aminosalicylate.…”

Segmental Colitis Associated Diverticulosis—A Possible Diagnosis in Teenagers

“…SCAD is a rare clinical entity, defined recently, and it is usually found in the elderly, affecting almost exclusively people > 50 years of age, especially males ( 15 , 16 ). Contrariwise, our case presented a potential diagnosis of SCAD in a 15-year-old female; hence, the mechanism of SCAD is not yet fully understood.…”

“…Similarly, our patient presented SCAD with UC-like changes and her prognosis was slowly favorable with severe rectal bleeding despite therapy with steroids, antibiotics, and salicylates (mesalazine). Fortunately, patients diagnosed with SCAD usually respond very well to an oral 5-aminosalicylate, but in cases with persistent chronically active and symptomatic disease, steroid therapy and/or surgical therapy might be required ( 16 ). Although our patient was initially burdened by severe rectal bleeding, which prompted multiple blood transfusions, after ~2 weeks of oral steroids and 5-aminosalicylate, her symptomatology considerably improved, without any signs of relapse after 6 months.…”

Editorial: mesalazine to prevent recurrent acute diverticulitis—the final nail in the coffin. Authors’ reply

“…Another subgroup of DD/diverticulitis is segmental colitis‐associated DD (SCAD), which is poorly studied. No formal trials are existing, but many doctors treat their patients with mesalazine.…”