title: Morphologic Basis for Developing Diverticular Disease, Diverticulitis, and Diverticular Bleeding.
abstract: Diverticula of the colon are pseudodiverticula defined by multiple outpouchings of the mucosal and submucosal layers penetrating through weak spots of the muscle coat along intramural blood vessels. A complete prolapse consists of a diverticular opening, a narrowed neck, and a thinned diverticular dome underneath the serosal covering. The susceptibility of diverticula to inflammation is explained by local ischemia, translocation of pathogens due to retained stool, stercoral trauma by fecaliths, and microperforations. Local inflammation may lead to phlegmonous diverticulitis, paracolic/mesocolic abscess, bowel perforation, peritonitis, fistula formation, and stenotic strictures. Diverticular bleeding is due to an asymmetric rupture of distended vasa recta at the diverticular dome and not primarily linked to inflammation. Structural and functional changes of the bowel wall in diverticular disease comprise: i) Altered amount, composition, and metabolism of connective tissue; ii) Enteric myopathy with muscular thickening, deranged architecture, and altered myofilament composition; iii) Enteric neuropathy with hypoganglionosis, neurotransmitter imbalance, deficiency of neurotrophic factors and nerve fiber remodeling; and iv) Disturbed intestinal motility both in vivo (increased intraluminal pressure, motility index, high-amplitude propagated contractions) and in vitro (altered spontaneous and pharmacologically triggered contractility). Besides established etiologic factors, recent studies suggest that novel pathophysiologic concepts should be considered in the pathogenesis of diverticular disease.
authors.affiliation: Institute of Anatomy, Christian-Albrechts-University of Kiel, Kiel, Germany.
authors.forename: Thilo
authors.initials: T
authors.lastname: Wedel
authors.affiliation: Institute of Anatomy, Christian-Albrechts-University of Kiel, Kiel, Germany.
authors.forename: Martina
authors.initials: M
authors.lastname: Barrenschee
authors.affiliation: Institute of Anatomy, Christian-Albrechts-University of Kiel, Kiel, Germany.
authors.forename: Christina
authors.initials: C
authors.lastname: Lange
authors.affiliation: Institute of Anatomy, Christian-Albrechts-University of Kiel, Kiel, Germany.
authors.forename: François
authors.initials: F
authors.lastname: Cossais
authors.affiliation: Institute of Anatomy, Christian-Albrechts-University of Kiel, Kiel, Germany.
authors.forename: Martina
authors.initials: M
authors.lastname: Böttner
keywords: Connective tissue; Diverticular disease; Enteric musculature; Enteric nervous system; Intestinal motility