Diverticulitis pathophysiology
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2]
Overview
Diverticula is a protrusion of the intestinal layers consisting of mucosa and serosa. It occurs mainly on the left side more than the right side. Diverticulitis is the inflammation of this protrusion. The first step in the pathogenesis of diverticulitis is the increase of intraluminal pressure, change of the intestinal motility and bacterial colonization. The inflammation is caused by histamine, tumor necrosis factor and metalloproteinases which were found in diverticulitis patient's tissue biopsies. Obstruction of the diverticula leads to bacteria colonization which leads to inflammation in the end.
Pathophysiology
Pathogenesis
Pathogenesis of diverticulitis is believed to be erosion in the wall of the diverticulum. It is worsened by the increase of the intraluminal pressure or the food remnants.
- Diverticula is a protrusion of the intestinal layers consisting of mucosa and serosa. It occurs mainly on the left side more than the right side. Diverticulitis is the inflammation of this protrusion.
- Inflammation and focal necrosis ensue, resulting in perforation and inflammation.[1]
- Pathogenesis of diverticulitis includes three main processes which are:
- Change of the intestinal motility
- Increase of the luminal pressure
- Colonic microbial flora may lead to secondary infection.[2]
- In vivo test showed that adding chemicals to the colonic tissue can lead to diverticulitis. Neuro-alteration of the tissue was noticed during this test. It showed increase contractility and loss of relaxation.[3]This alteration in the muscle tissue due to the inflammation which leads to histological changes of the muscle and nerves.
- The mechanism of the inflammation in cases of diverticulitis is known to be caused by histamine, tumor necrosis factor and matrix metalloproteinases. These substances were detected in the colonic tissue biopsies in diverticulitis patients.[4]
- Collection of feces and undigested food in the diverticula leads to diverticulum obstruction. This obstruction and by increasing the intraluminal pressure leads to diverticulum distension and collection of the bacteria that ends up into inflammation.
- Presence of lymphocytes and granulomas are more predictable of chronic inflammation.
Histopathological Findings
The possible histopathological findings of diverticulitis may show the following:
- Abscess at which neutrophils, lymphocytes and fibrosis are observed.
- Sulfur granules with peripheral inflammatory cells.
A brief video showing histopathological findings in patients of diverticulitis:{{#ev:youtube|pvasI_yy3R4}}
References
- ↑ Rege RV, Nahrwold DL (1989). "Diverticular disease". Curr Probl Surg. 26 (3): 133–89. PMID 2651018.
- ↑ Morris AM, Regenbogen SE, Hardiman KM, Hendren S (2014). "Sigmoid diverticulitis: a systematic review". JAMA. 311 (3): 287–97. doi:10.1001/jama.2013.282025. PMID 24430321.
- ↑ Guagnini F, Valenti M, Mukenge S, Matias I, Bianchetti A, Di Palo S; et al. (2006). "Neural contractions in colonic strips from patients with diverticular disease: role of endocannabinoids and substance P." Gut. 55 (7): 946–53. doi:10.1136/gut.2005.076372. PMC 1856307. PMID 16423891.
- ↑ Tursi A, Elisei W, Brandimarte G, Giorgetti GM, Inchingolo CD, Nenna R; et al. (2012). "Mucosal expression of basic fibroblastic growth factor, Syndecan 1 and tumor necrosis factor-alpha in diverticular disease of the colon: a case-control study". Neurogastroenterol Motil. 24 (9): 836-e396. doi:10.1111/j.1365-2982.2012.01946.x. PMID 22680042.