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Postgrad Med J 2002;78:654-658 doi:10.1136/pmj.78.925.654
  • Review

Epidemiology of perforated colonic diverticular disease

  1. C R Morris1,
  2. I M Harvey1,
  3. W S L Stebbings2,
  4. C T M Speakman2,
  5. H J Kennedy3,
  6. A R Hart1
  1. 1School of Medicine, Health Policy and Practice, University of East Anglia, Norwich
  2. 2Department of Surgery, Norfolk and Norwich University Hospital NHS Trust
  3. 3Department of Gastroenterology, Norfolk and Norwich University Hospital NHS Trust
  1. Correspondence to:
 Mr C R Morris, School of Medicine, Health Policy and Practice, Elizabeth Fry Building, University of East Anglia, Norwich NR4 7TJ, UK; 
 christopher.morris{at}uea.ac.uk
  • Received 25 April 2002
  • Accepted 22 July 2002

Abstract

Perforated colonic diverticular disease results in considerable mortality and morbidity. This review appraises existing evidence on the epidemiology and mechanisms of perforation, highlights areas of further study, and suggests an epidemiological approach towards preventing the condition. Computerised searches were used to identify published articles relating to the epidemiology, pathophysiology, and clinical features of perforated colonic diverticular disease. Several drug and dietary exposures have potential biological mechanisms for causing perforation. Of these only non-steroidal anti-inflammatory drugs have been consistently identified as risk factors in aetiological studies. The causes of perforated colonic diverticular disease remain largely unknown. Further aetiological studies, looking specifically at perforation, are required to investigate whether cause-effect relationships exist for both drug and dietary exposures. The identification of risk factors for perforation would allow primary public health prevention, secondary risk factor modification, and early prophylactic surgery to be aimed at people at high risk.

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