Segmental Colitis Complicating Diverticular Disease

Abstract

Two cases of idiopathic colitis affecting the sigmoid colon in elderly patients with underlying diverticulosis are presented. Segmental resection has permitted close review of the histopathology in this syndrome which demonstrates considerable similarity to changes seen in idiopathic ulcerative colitis. The reported experience with this syndrome and its clinical features are reviewed.

Natural History and Long-Term Clinical Behavior of Segmental Colitis Associated with Diverticulosis (Scad Syndrome)

“…The findings in this cohort of patients confirm some prior observations described for this distinctive entity in earlier case studies [1][2][3][4][5][6][7][8][9][10][11][12] and also provide some new information. First, although there were only a limited number of patients here that fulfilled the criteria to define SCAD, males appeared to be affected more often than females, and this entity usually, although not exclusively, occurred in middle-aged to elderly patients.…”

“…These findings are consistent with the sex and age distribution for SCAD previously reported for other series and case reports [1][2][3][4][5][6][7][8][9][10][11][12], but differ from previous published findings from our hospital for other forms of inflammatory bowel disease, such as Crohn's disease, which documented a predominately female sex distribution as well as a younger age (more than 80% under the age of 40 years) [15,16]. Moreover, the results in this population with segmental colitis and diverticulosis also differ from a predominately female distribution previously detailed from this hospital with Crohn's disease localized to the colon that had histologically defined granulomatous inflammation (P \ 0.05) [17].…”

“…SCAD occurs primarily in the elderly and has been empirically treated with the same medications used for other forms of inflammatory bowel disease. Although now better appreciated as a distinctive inflammatory process, its etiology and pathogenesis still require elucidation [1][2][3][4][5][6][7][8][9][10][11][12]. While infectious, immunological, and ischemic factors have been considered, little information is available on its natural history and long-term clinical behavior.…”

Diverticular Colitis

“…However, it has been shown that DC is the final result of divergent pathologic factors. Other cases may represent a mass effect, where luminal inflammation is found directly overlying a peridiverticular abscess [7] or the result of increased exposure to intraluminal antigens and toxins because of relative stasis [8]. These redundant mucosal folds are exposed to more mechanical stresses, especially when the stool is firm, leading to ischemia, ulceration, and inflammation [1,2].…”

“…These microscopic features strongly mimic CIBD, specifically UC [1,2,4,5,9]. This form of DC may also respond to medications similar to that used in CIBD [1,4,8,10].…”