Diverticulosis coli is an anatomic abnormality of the large bowel wall that manifests itself in various ways. Its occurrence varies greatly with such factors as geographic location, dietary habits, race, and age. In the United States, a third of the population over age 50 is affected.

The diagnosis of diverticulosis coli is often made incidentally in otherwise asymptomatic patients at the time of routine surveillance endoscopy or barium enema x-ray examination. However, unless a stricture is present, most of these patients require only counseling about possible infectious or hemorrhagic complications of the disease and the need for prophylactic measures such as a fiber-rich diet, adequate fluid consumption, and the prevention of constipation.

When clinical manifestations of diverticulosis occur, surgical intervention is necessary in only a minority of patients. These patients may have massive, or recurrent, gastrointestinal bleeding but more commonly have localized intra-abdominal abscess or generalized peritonitis that has developed after diverticular perforation.

Clinically significant diverticular disease and its complications continue to tax the diagnostic and therapeutic skills of physicians. Physical findings range from diffuse slight abdominal tenderness to shock secondary to either massive hemorrhage or overwhelming sepsis. During such life-threatening emergencies, the physician must be prepared to resuscitate the patient quickly and proceed to surgical intervention without benefit of a definite diagnosis.