20 Gauge Sabots For Reloading, Cabela's 7 In 1 Smoker Manual, Articles P

Segmental colitis associated with diverticulitis (SCAD) is an inflammatory condition affecting the colon in segments that are also affected by diverticulosis, namely, the sigmoid colon. Moldovan C, Rusu E, Cochior D, Toba ME, Mocanu H, Adam R, Rimbu M, Ghenea A, Savulescu F, Godoroja D, Botea F. World J Clin Cases. The https:// ensures that you are connecting to the These two terms are interchangeable. Careers. The most common location for diverticulitis is the sigmoid colon, which is the S-shaped near end portion of your colon. Stress, Anxiety, Mental Health - St. Dymphna. It's not exactly clear why people develop diverticular disease, but there are several different causes. Surgery is needed if problems develop. Complicated diverticulitis is defined as diverticulitis associated with localized or generalized perforation, localized or distant abscess, fistula, stricture or obstruction. She was diagnosed with ulcerative colitis at age 16. Last reviewed by a Cleveland Clinic medical professional on 04/01/2020. Researchers are unsure why this happens and how fiber in a diet contributes to or protects against the development of diverticulitis. Some of the symptoms can include: In around 95% of people with uncomplicated diverticulitis, an attack usually lasts a week or less before subsiding on its own. (http://health.gov/dietaryguidelines/2015). If the affected area of your colon is removed, another surgery is usually not needed. The colostomy bag may be needed for several months while your colon heals. For acute diverticulitis, a number of surgical approaches exist, including loop colostomy, sigmoidectomy with colostomy (Hartmanns procedure) and sigmoidectomy with primary colorectal anastomosis. This connection is called a fistula. Marked sigmoid colon thickening with luminal narrowing secondary to chronic sigmoid diverticulitis. Diverticulitis can cause symptoms including abdominal pain. PMC Both a diverticulitis attack and a diverticulitis flare-up refer to the onset of symptoms of diverticulitis. Intestinal inflammation from diverticulitis can lead to the development of fistulas that connect the large intestine with other organs. This connection is called a fistula and may require surgery to fix. Overview of Urinary Tract Infections (UTIs), Computed Tomography and Magnetic Resonance Imaging of the Digestive Tract, Ultrasound Scanning (Ultrasonography) of the Abdomen. Less than 5% of people with diverticulosis develop diverticulitis. Abscesses can be treated with percutaneous drainage if the abscess is large enough. Diverticula most commonly occur along the mesenteric side of the antimesenteric taeniae resulting in parallel rows. Verywell Health's content is for informational and educational purposes only. o [ pediatric abdominal pain ] Surgery - St. Luke the Evangelist. National Institute of Diabetes and Digestive and Kidney Diseases. If these pouches. Left untreated, it can worsen and lead to an abscess or bowel obstruction. This article describes what you may experience if you are having a diverticulitis attack and how to know when the symptoms require a call to a healthcare professional. Other symptoms can include fever, chills, constipation, diarrhea, nausea, and vomiting. Sometimes, inflammation irritates nearby blood vessels and causes bleeding into the large bowel. Diverticular disease was rarely described in the literature prior to the 1900s. Emerging evidence and recent controversies in diverticulitis: a 5-year review. We do not control or have responsibility for the content of any third-party site. Technical considerations for elective cases include appropriate bowel preparation, the use of a laparoscopic approach, the decision to perform a primary anastomosis, and the selected use of ureteral stents. For severe diverticulitis, no food or fluids by mouth and antibiotics. Quiet yourself in the Lord's presence, perhaps by praying in the Spirit for a few moments. Also, some people experience urinary tract infections after surgery. 2022 Oct;74(5):1665-1673. doi: 10.1007/s13304-022-01324-3. The resulting inflammation along with the bacterial contents of the large intestine slowly penetrate the nearby organ, resulting in a fistula. Patient factors including severity of disease, tissue quality, and comorbidities should be considered. Besides preventing constipation, eating a high-fiber diet helps lower blood pressure, reduces blood cholesterol, improves blood sugar and reduces the risk of developing certain intestinal disorders such as colorectal cancer. The patient should undergo a full antibiotic bowel preparation. Factors that may lead to inflamed diverticula and causing symptoms include: Diverticulitis usually results when several of these factors combine to cause an inflammation of the diverticula. Uncomplicated diverticulitis might get better with some conservative treatment at home. There are clearly patients who would do well with an elective colectomy and a subset who could avoid an operation all together however, the challenge is appropriate risk-stratification and patient selection. The reason that diverticulitis develops has not been entirely confirmed, but it is believed to be because faeces becomes trapped within a diverticulum. Finally, consider ureteral catheters, diverting loop ileostomy, and be prepared for all anastomotic options in advance. They can show up anywhere. Diverticulitis occurs when one of those diverticula becomes inflamed, causing symptoms of abdominal pain, tenderness, and sometimes fever. Hospitalization is usually necessary for patients with immunosuppression, intolerance to oral intake, signs of severe sepsis, lack of social support and increased comorbidities. Blood may be easily seen by the naked eye (overt), or blood may be present in amounts read more . Small outpouchings in your large bowel are very common in patients over age 50, a condition known as diverticulosis. Colostomy takedown operations are challenging surgeries. For a disease process that affects so many, we continue to struggle to define optimal care for patients with diverticular disease. Most people have constant abdominal pain and a fever. Thickened sigmoid colon with adjacent mesenteric stranding consistent with acute uncomplicated sigmoid diverticulitis. This condition is very common and increases with age. The role of antibiotics has been questioned in a number of randomized controlled trials and it is likely that we will see more patients with uncomplicated disease treated with observation in the future. She was diagnosed with ulcerative colitis at age 16. government site. Bouzid A, Kardoun N, Fourati K, Amar MB, Boujelbene S. Clin Case Rep. 2022 Aug 14;10(8):e6253. Arrow marks fistulous tract and colocutaneous fistula. Outside links: For the convenience of our users, RadiologyInfo.org provides links to relevant websites. When diverticulitis flares up, people need to rest their bowels (intestines). vacation rental inspector job description A diverticulum is a small pouch that forms in the wall of the colon. More serious pain may require treatment in the hospital. Colonoscopy usually needs to be delayed for 1 to 3 months after treatment because it can damage or rupture an inflamed intestine. Left untreated, it can worsen and lead to an abscess or bowel obstruction. Sometimes, after talking with their doctor, people choose to have elective surgery (surgery that is not needed immediately and can be put off for some time) to manage their diverticular disease. The main symptom of a diverticulitis attack is pain on the left side of the abdomen. More severe cases may require IV antibiotics or surgery if complications occur. Colorectal Surgery, Minimally Invasive Surgery, A condition in which a small sac forms along the colon and becomes blocked or inflamed, Symptoms include cramps, nausea, vomiting, fever, and constipation, Treatments include IV antibiotics or oral antibiotics and a clear liquid diet for several days. The cause of diverticulosis is unknown but may be related to diet, a sedentary read more may be.). Diverticulitis causes abdominal pain, tenderness, and sometimes fever. If youve had a previous episode of diverticulitis, you have up to about a 20% chance of having a repeat episode. The management of diverticulitis: a review of the guidelines. The optimal long-term strategy for patients who undergo successful non-operative management of their diverticular abscess remains controversial. By Amber J. Tresca The site is secure. The surgeon removes the involved section of the intestine. Diverticulitis has increased in incidence over the past few decades, becoming a major healthcare burden for Western countries. Diverticula are one or more pockets or bulges that form in the wall of your colon. Johns Hopkins Medicine. Probiotics may be helpful in preventing constipation however. Diverticulosis is the presence of one or more balloon-like sacs (diverticula), usually in the large intestine. However, most cases require antibiotics. Diverticular disease case study. To help ensure current and accurate information, we do not permit copying but encourage linking to this site. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). 2008 Nov-Dec;42(10):1142-4. doi: 10.1097/MCG.0b013e3181862ab1. Policy. Amber J. Tresca is a freelance writer and speaker who covers digestive conditions, including IBD. However, when these outpouchings become inflamed, diverticulitis results. Colorectal Cancer: What Millennials and Gen Zers Need to Know, Cramps and extreme tenderness in your abdomen, Certain medications, including steroids and opioids, Certain genetically inherited diseases such as Marfan syndrome and Ehlers-Danlos disease, both of which affect connective tissue in the body and appear to increase an individuals risk of developing the sacs at a younger age, CT scan, X-ray, and abdominal ultrasound imaging tests. Use to remove results with certain terms Usually, diverticulitis can be resolved with mild treatments, including temporary diet changes and sometimes antibiotics. Use for phrases See this image and copyright information in PMC. Without treatment, there could be complications such as: Its not known exactly what causes diverticular disease. In the majority of cases, a diverticulitis attack will resolve within a week with conservative treatment. National Institute of Diabetes and Digestive and Kidney Diseases. 8600 Rockville Pike Between 5% and 15% will develop rectal bleeding. Some researchers believe not having the proper balance of good bacteria in your gut may play a role in the development of diverticulitis. 2019 Nov;211(9):421-427. doi: 10.5694/mja2.50276. Small pouches called diverticula can form in the large intestine. Less commonly, a fistula can develop between the large intestine and the small intestine, uterus, vagina, abdominal wall, or even the thigh. A colostomy is an opening between the large intestine and the skin surface. 2017;8(1):19-27. doi:10.1007/s13244-016-0532-3. Onur MR. Akpinar E, Karaosmanoglu AD, et al. Elective surgery is typically considered for people who have had multiple attacks of diverticulitis or for those who have a complication such as narrowing of the colon due to scarring. Symptoms & causes of diverticular disease. (Pain is the most common symptom.). This helps move waste to the rectumour signal that we need to find a bathroom. Rectal diverticula are mostly asymptomatic and diagnosed incidentally in the majority of patients and rarely require treatment. Surgery may be needed if you develop complications or if other treatment methods fail and your diverticulitis is severe. 2018;41:111-119. doi:10.1097/sga.0000000000000307. Differential diagnosis, Diverticulitis: a comprehensive review with usual and unusual complications, An inability to keep any food or water down, Perforation: A tear that causes the contents of the large bowel to leak into the abdomen. In fact . If you have symptoms such as abdominal pain and bleeding, seek care from a healthcare provider to determine the cause. Mild diverticulitis can be treated at home with rest. It can also create a hole in your colon that connects to other structures, such as your bladder or other parts of your intestines. Our gastroenterologists rely on the latest evidence when deciding the best course of treatment for each patient. Because each person is different, be sure to ask your healthcare provider, surgeon, or colon specialist about your risk for return appearance of diverticulitis. Other symptoms can include fever and chills, nausea, vomiting, and. Diverticulosis and diverticulitis are two conditions that occur in your large intestine (colon). The best self-treatment is to eat a high-fiber diet (one filled with fruits and vegetables, cereals and whole grains, nuts, beans and legumes. The link you have selected will take you to a third-party website. A diet rich in fiber is encouraged. Your doctor will likely start with a physical exam and medical history. Since its inception in the late 90s, laparoscopic lavage has been recognized as a novel treatment modality in the management of complicated diverticulitis; specifically, Hinchey III (purulent) diverticulitis. Some, but not all, patients require hospitalization. Patients with recurring diverticulitis or those who have a narrowing of the large bowel from repeated episodes of inflammation may also need surgery. There could be another reason for the symptoms or a complication caused by diverticulitis. This most commonly involves a lower part of your bowel called the sigmoid colon. Ten-year multicentric retrospective analysis regarding postoperative complications and impact of comorbidities in hemorrhoidal surgery with literature review. Most case of SCAD resolve with a high-fiber diet and antibiotics, with salicylates reserved for more severe cases. SCAD affects approximately 1.4% of the general population and 1.15 to 11.4% of those with diverticulosis and most commonly affects those in their 6th decade of life. The pain may be the only sign of the need for surgery read more is infection of the abdominal cavity, which can develop if the wall of a diverticulum ruptures. How Do You Know If You Are Having a Diverticulitis Attack? Pregnancy test: If you are of childbearing age, your doctor may ask you to take a pregnancy test. Please enable it to take advantage of the complete set of features! Pray the following prayer aloud, slowly, incorporating pictures, vision, flow and emotion, as this is what makes it a heart prayer and not simply a head prayer. Please contact your physician with specific medical questions or for a referral to a radiologist or other physician. People who have severe symptoms, such as abdominal pain, body temperature above 101 F (38.3 C), and other evidence of serious infection or complications, are hospitalized. This includes optimization of patient risk factors as well as tailoring the surgical approach and perioperative management. Enter search terms to find related medical topics, multimedia and more. What Does a Diverticulitis Attack Feel Like? Repeated episodes of diverticulitis can cause scarring which can narrow the large bowel and cause an obstruction. When you visit the site, Dotdash Meredith and its partners may store or retrieve information on your browser, mostly in the form of cookies. Patients with severe cases of diverticulitis may require intravenous antibiotics and fluids for several days. You may feel aching or cramping. To push along digested food, muscles along the colon wall contract, applying pressure in a wavelike motion along the full length of the colon. Magnetic resonance imaging Computed Tomography and Magnetic Resonance Imaging of the Digestive Tract Computed tomography (CT see also Computed Tomography (CT)) and magnetic resonance imaging (MRI see also Magnetic Resonance Imaging (MRI)) scans are good tools for assessing the size and location read more (MRI) is an alternative test for pregnant women or young people. Vegetables, such as broccoli, cabbage, spinach, carrots, asparagus, squash and beans. Retroileal pull-through: A) Anatomic Configuration B) X-ray Contrasted Depiction of Anatomy. The costs for specific medical imaging tests, treatments and procedures may vary by geographic region. Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Acute diverticulitis can be further sub classified into complicated and uncomplicated presentations. A fistula is an abnormal channel connecting one organ with another or with the skin. Doctors often diagnose diverticulitis using a computed tomography (CT) scan of your abdomen and pelvis. Pain that cant be treated at home might need management in the hospital with intravenous pain medications. About 10 to 12 weeks later (or sometimes longer), after the inflammation has gone away and the person's condition has improved, the cut ends of the intestine are rejoined during a follow-up operation, and the colostomy is closed. A diverticulum is a small pouch that forms in the wall of the colon. Overall, data suggest that primary anastomosis is preferable to a Hartmans procedure in select patients with acute diverticulitis. The double stapled colorectal anastomosis. However, some people report: Keep in mind that having one or more of these symptoms doesnt mean you have diverticulosis. If pain or other symptoms dont get better, see a healthcare provider and get reevaluated. Without its strong elasticity, the lining can bulge through the colon wall, forming a sac or pouch, a condition called diverticulosis. To understand where we are currently, it is worth understanding how treatment of diverticular disease has evolved. Both share the common feature of diverticula. The most common symptom of diverticulitis is belly or abdominal pain. First, your healthcare provider will ask you about your medical history including your current symptoms, the types of foods you normally eat, how often you have bowel movements and other questions about your bowel movements, and will review any medications you are currently taking. Yes, you can take a fiber supplement. Surgery for diverticulitis is considered if you have: Surgery usually involves removing part of the colon. Not eating enough fiber causes a buildup of waste (constipation) in your colon. Diverticulosis and diverticulitis. Relapse is uncommon and immunosuppression with steroids is rarely needed. Diverticulitis usually causes pain in the lower left part of your abdomen while appendicitis usually causes pain in the lower right part of your abdomen. Epub 2019 Jul 28. For some people, including those who have small abscesses, rest and sometimes antibiotics are all that are needed to treat severe diverticulitis. The most common symptom of diverticulitis is a sharp cramp-like pain, usually on the left side of your lower abdomen. You may need colon surgery if you develop complications such as a bowel perforation, abscess, fistula, or intestinal obstruction. Severe diverticulitis requires different treatment. Repeated bouts of diverticulitis can lead to narrowing (stricture) of the colon because the resulting scarring and muscle thickening can narrow the inside of the large intestine and prevent solid stool from passing through. More clinical trials are needed on these medications. Diverticulitis can be a serious, and even a potentially life-threatening complication. You and your surgeon will discuss the details of your specific surgery including risks, complications and what to expect after surgery. Unable to load your collection due to an error, Unable to load your delegates due to an error. Learn about symptoms and treatment. Uncomplicated diverticulitis is characterized by inflammation limited to colonic wall and surrounding tissue. It can be severe in people of any age, although it is most serious in older people, especially those taking corticosteroids or other medications that suppress the immune system and thus increase the risk of infection, including colon infection. Verywell Health's content is for informational and educational purposes only. Diverticulitis typically does not cause gastrointestinal bleeding Gastrointestinal Bleeding Bleeding may occur anywhere along the digestive (gastrointestinal [GI]) tract, from the mouth to the anus. An abnormal channel (fistula) may form between the large intestine and another organ, usually when a diverticulum that touches another organ ruptures. The exact pathogenesis of SCAD is unknown, but proposed mechanisms include mucosal redundancy and prolapse occurring in diverticular segments, fecal stasis, and localized ischemia. This site needs JavaScript to work properly. This approach allows the colon to rest. A CT scan Computed Tomography (CT) In computed tomography (CT), which used to be called computed axial tomography (CAT), an x-ray source and x-ray detector rotate around a person. Gut. Many centers will also ask that you drink a form of oral contrast. 2023 Dotdash Media, Inc. All rights reserved. 2015;31:76-82. doi:10.1159/000381431, Barbara G, Scaioli E, Barbaro MR, et al. The National Institute of Diabetes and Digestive and Kidney Disease recommends eating 14 grams per 1,000 calories consumed per day. Bacteria contained within the faeces starts to grow in number . Together they are known as diverticular disease. 2016;91:1094-1104. doi:10.1016/j.mayocp.2016.03.012. Mayo Clin Proc. A . Clin Colon Rectal Surg. National Institute of Diabetes and Digestive and Kidney Disease. Diverticular disease is an umbrella term that includes both diverticulosis and diverticulitis, as well as diverticular bleeding. Visit our Butts & Guts Podcasts page to learn more about digestive conditions and treatment options from Cleveland Clinic experts. The diverticulum is a sac-like protrusion of the colon wall. The earliest records show that people and churches were named after apostles and martyrs as early as the fourth century. doi: 10.1002/ccr3.6253. Yale Medicines expert team of digestive disease physicians and surgeons can help determine the best course of treatment for patients with diverticulitis. Available products include FiberCon, Citrucel, Metamucil and generics of these branded products and other fiber products. Viszeralmedizin. eCollection 2023 Jan. Arnott SM, Arnautovic A, Haviland S, Ng M, Obias V. J Robot Surg. Symptoms of diverticulitis typically include pain and/or tenderness (usually in the left lower part of the abdomen), fever, and sometimes nausea and vomiting. Diverticulitis can be simple or uncomplicated and complicated. Diverticulitis can be treated and be healed with antibiotics. Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Other possible complications of diverticulitis include inflammation of nearby organs (such as the uterus, bladder, or other areas of the digestive tract). In the late 1960s and early 1970s, Painter and Burkitt popularized the theory that diverticulosis is a disease of Western civilization based on the observation that diverticulosis was rare in rural Africa but common in economically developed countries. Accessibility Occasionally surgery is necessary to repair a section of the colon with a burst pouch or to correct a fistulaan abnormal connectionthat a pouch may have formed with a nearby organ. Arrow marks, Colocutaneous fistula secondary to diverticular. HHS Vulnerability Disclosure, Help Safety of robotic surgical management of non-elective colectomies for diverticulitis compared to laparoscopic surgery. (https://link.springer.com/article/10.1007%2Fs13244-016-0532-3), (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5265196/), Visitation, mask requirements and COVID-19 information, nonsteroidal anti-inflammatory drugs (NSAIDs). Diverticulosis usually causes no symptoms. Be careful not to fall asleep with the heating pad on. Diverticulitis develops when a single sac (diverticulum) becomes blocked or filled by a piece of stool in the colon. Before 2023 Jan 16;11(2):366-384. doi: 10.12998/wjcc.v11.i2.366. While sigmoid colon involvement is considered the most common site of colonic diverticulitis in Western countries, diverticular disease can be problematic in other areas of the colon. Algorithm for selecting appropriate patients for out-patient management. Another theory is that the walls of the diverticula itself erode from the increased pressure on the colon walls. Please confirm that you are not located inside the Russian Federation. More recent data has challenged prior concerns about decreasing effectiveness of medical management with repeat episodes and the notion that the natural history of diverticulitis is progressive. This is rare and will usually present with a large amount of red or maroon color stool. The symptoms of a diverticulitis attack can be similar to many other common digestive problems. Read our. In Asian countries, right-sided diverticulitis outnumbers the left. Sonal Kumar, MD, MPH, is a board-certified gastroenterologist and hepatologist at Weill Cornell Medicine/New York Presbyterian Hospital, where she is an Assistant Professor of Medicine and the Director of Clinical Hepatology. Who is at risk of developing diverticulitis? After 1 to 3 months, people have a colonoscopy to evaluate the colon. Diverticulitis accounts for an estimated 371,000 emergency department visits and 200,000 inpatient admissions per year with annual cost of 2.12.6 billion dollars per year in the United States. An attack of diverticulitis usually resolves completely. Koprowski MA, Affleck A, Tsikitis VL. , MD, Icahn School of Medicine at Mount Sinai; Diverticulitis usually affects the large intestine (colon). Retroileal pull-through: A) Anatomic Configuration. Depending on the extent and severity of disease, surgery can be performed in a single surgery, in two surgeries, in an open procedure (tradition surgery performed through a large incision) or by a minimally invasive laparoscopic procedure (surgery performed through small holes in your abdomen). Most people who have diverticulitis will recover with about a seven to 10-day course of antibiotics and rest. Your healthcare provider will check your abdomen for pain and tenderness. Pain, tenderness or sensitivity in the left lower side of your abdomen. Every attempt should be made to improve a patients chance of successful surgery. While SCAD is considered a separate clinical entity, it is frequently confused with diverticulitis or inflammatory bowel disease (IBD). Severe abdominal pain that comes on quickly, however, almost always indicates a significant problem. Other people who need surgery include those who have severe diverticulitis symptoms that are not relieved by nonsurgical treatment (such as antibiotics) within 3 to 5 days. A positive outcome depends greatly on thoughtful attention to what makes a complicated patient complicated. Diverticulitis occurs in people with diverticulosis Diverticulosis of the Large Intestine Diverticulosis is the presence of one or more balloon-like sacs (diverticula), usually in the large intestine (colon). 2022;35:8-16. doi:10.20524/aog.2021.0677, Ticinesi A, Nouvenne A, Corrente V, et al. The most common symptom of diverticulitis is abdominal pain, which tends to be constant and may also last for several days. National Library of Medicine If you've already been diagnosed with diverticulosis or have previously experienced a flare-up of diverticulitis, you might assume you are having an attackand you might be right. Resection of diseased bowel to healthy proximal colon and rectal margins remains a fundamental principle of treatment although the operative approach may vary. It can also create a hole in your colon that connects to other structures, such as your . If symptoms dont get better with treatment, its important to go for follow-up care. 2022 Oct 18;36(1):57-62. doi: 10.1055/s-0042-1756511. It might be felt in the lower-left quadrant (quarter) of the abdomen, the lower-right quadrant, or at the pubic bone. The possibilities are endless, as there are saints to pray to for just about every ache and pain known to man. It may not be possible to know that abdominal pain is from diverticulitis if its the first time youre experiencing symptoms. Peritonitis Peritonitis Abdominal pain is common and often minor. Management of patients with perforation depends greatly on the presence of feculent or purulent peritonitis, the extent of contamination and hemodynamic status and associated comorbidities. 2015;31(2):84-94. doi:10.1159/000381867. Rectal bleeding can occur, but it is not common in diverticulitis. If a doctor knows that the person already has diverticulosis Diverticulosis of the Large Intestine Diverticulosis is the presence of one or more balloon-like sacs (diverticula), usually in the large intestine (colon). If symptoms ease in a few days, you will gradually return to solid food. Most people have constant abdominal pain and a fever. How is diverticulitis diagnosed and evaluated? If the patient doesnt improve, then surgery of the colon to remove sections with diverticula may be required. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); Diverticular disease and diverticulitis: Treating acute diverticulitis. If a diverticulum ruptures, the contents of the intestine, including bacteria and blood, spill into the abdominal cavity, often causing infection. Endoscopy can also be used to treat many disorders because doctors are able to pass instruments read more (an examination of the large intestine using a flexible viewing tube) to rule out colon cancer. You can find out more about our use, change your default settings, and withdraw your consent at any time with effect for the future by visiting Cookies Settings, which can also be found in the footer of the site. Brought to you by Merck & Co, Inc., Rahway, NJ, USA (known as MSD outside the US and Canada)dedicated to using leading-edge science to save and improve lives around the world. Overall, the management of diverticular disease depends greatly on patient, disease and surgeon factors.