complications of diverticular disease

Last edited 09/2018

complication of diverticular disease

  • perforation
    • caused by severe inflammation of bowel wall layers with subsequent necrosis and loss of intestinal wall integrity
    • almost always occurs on the left side
    • well contained perforations are usually small and self-limited and free air is usually detected locally, in non-contained perforation (1-2% of patients with acute diverticulitis), local abscess and fistula formation may occur with widespread intraabdominal free air

  • abscess
    • abscesses may be detected in up to 30% of patients with acute diverticulitis
    • remote site of absecess formation may occur e.g. - liver, adnexa, lung and rare localizations such as brain and spine
    • management depends on the size, location and overall condition of the patient

  • pylephlebitis
    • also called ascending septic thrombophlebitis, pylephlebitis is a condition characterised by infective suppurative thrombosis of either the portal vein or its branches, or both
      • most commonly involved are - thrombosis of the superior mesenteric vein (42%), followed by portal vein (39%), and finally, the inferior mesenteric vein (IMV) (2%)
    • other causes of pylephlebitis include: appendicitis, necrotizing pancreatitis, bowel perforation, pelvic infection and inflammatory bowel disease

  • bowel obstruction
    • is a rare complication, partial obstruction (due to wall oedema and peripheral inflammation or abscess formation) may occur

  • bleeding
    • lower GI bleeding is present in 5% of colonic diverticulosis

  • fistula
    • fistula formation occurs at a rate of around 14% fter an episode of acute diverticulitis
    • results from a breach in wall integrity of adjacent structures due to a diverticular abscess
    • fistula formation following diverticulitis may be associated with the following structures: urinary bladder, ureter, other adjacent intestinal segments, gallbladder, uterus, fallopian tubes, vagina, skin, and the perianal region


  1. Onur MR, Akpinar E, Karaosmanoglu AD, Isayev C, Karcaaltincaba M. Diverticulitis: a comprehensive review with usual and unusual complications. Insights into Imaging. 2017;8(1):19-27