Table 2

Potential risk factors in diverticular perforation classified by biological mechanisms of action

Mecahnism of actionPathwayRisk factors
Raised intracolonic pressureAltered autonomic activityDecreased physical exercise25,26
Prostigmine/neostigmine27,28
Opioid receptorsOpioid drugs21,29–31
Reduced mechanical stretching of colonFibre deficiency32,33
Impaired mucosal barrierAltered microbial colonisationAntibiotics34,35
Fibre deficiency36
Altered mucin secretionNSAIDs37–39
Fibre deficiency40–42
Damaged epithelial cellsNSAIDs37–39
Red meat43,44
Decreased immune responseCorticosteroids and other immunosuppressants45
Advanced age46