Diverticular disease of the colon used to be considered a disease of the aging, while instead it should be labeled more appropriatedly a disease of the Western Civilization. Diverticular disease is virtually unknown is Africa and among the population that eats a diet very high in fibers. In our country, the incidence of diverticular disease has increased from 5% in 1909 to 50% in 1975.
It is also true that the presence of diverticulosis increases with age; it is quite rare before the age of 40, while about 1/3 of persons over 60 have diverticulosis. By the age of 70 about half of the people have diverticulosis. 

The cause of diverticular disease has been attributed to two main factors : 

1) Areas of weakness in the muscular layer of the bowel wall at the point of entrance of blood vessels, worsened by the aging process, 

(2) Increased pressure in the lumen of the bowel, secondary to the effort to move the stools forward. 

It has been discovered that the colon that handles a large volume of stools, generates lower pressures and is less prone to produce diverticulosis. A diet that is poor in fiber instead is responsible for harder and dryer stools, which require more forceful contraction to be moved along the bowel. This higher pressure would be responsible for the herniation of the internal lining of the bowel through the weak areas. This theory would consider the diverticulosis very similar to hernia. While it is very simple to understand and very attractive may not entirely reflect the cause of diverticulosis. 

Diverticulosis per se cause no clinical symptoms. 

The spastic condition of the bowel that is often associated with diverticulosis could be perceived as a sensation of cramps in the left lower quadrant. 

The complications of diverticulosis are what brings this condition to the attention of the patient and the physician. 

Acute diverticulitis is the most known and one of the most frequent. About ten to twenty five percent of patients with diverticular disease will develop one or more episodes of acute diverticulitis during their lifetime. There are several theories to explain the cause of acute diverticulitis. According to the mechanical theory, if a small piece of hard stool, or a particle of non-well chewed vegetable or nut blocks the neck of the diverticulum, accumulation of bacteria will cause inflammation and spreading infection. 

Acute diverticulitis could be mild and self limited and respond well to antibiotic treatment or could be more severe and evolve into an abscess or perforation. In the later case emergency surgery is usually needed and almost always involves the creation of a temporary colostomy. 

Diverticulitis may become chronic and eventually evolve into a stricture. The stricture could be the source of pain and sometimes also difficult to distinguish from a carcinoma. A diverticular stricture also requires surgery, but most of the time it can be performed electively after adequate preparation. This will not require a colostomy. 

Chronic diverticulitis may also evolve in a fistula with the bladder or the vagina. The presence of a fistula will always indicate the need for surgical intervention. 

Bleeding from diverticular disease occurs in about 5% of patient. It is usually massive and frightens the patient, but fortunately stops spontaneously in about 70% of the cases. Since the bleeding recurs in about 20% of patients, surgery is not recommended for the first episode of self limited bleeding; resection of part of the colon is recommended after the second episode of bleeding. 

Diverticulosis non complicated	Diverticular bleeding	Laparoscopic left colectomy-camera
Sigmoid colon exteriorized and ready for resection	Anastomosis between descending colon and rectum