Harrison's PodClass: Internal Medicine Cases and Board Prep Ep 182: A 64-Year-Old with Abnormal Colonoscopy
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Feb 12, 2026 A 64-year-old colonoscopy finds diverticulosis and sparks a deep dive into diverticular disease. Topics include rising global incidence and who is most affected. They cover risk factors beyond diet, common locations in the colon, and main complications like bleeding and diverticulitis. Practical points include diagnosis with CT, outpatient management, antibiotic use, and diet myths about nuts and seeds.
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Diverticulosis Is Extremely Common And Costly
- Diverticulosis affects about half of people over 60 and is often asymptomatic.
- It has become the fifth most costly GI disorder in the U.S. and is the leading reason for elective colon resection, driven by rising incidence.
Diverticula Localize To Sigmoid But Vary By Population
- Diverticula most often occur in the sigmoid colon where vasa recta penetrate the muscularis, sparing the rectum.
- In Asian populations, diverticula are more commonly right-sided (cecum and right colon), for unclear reasons.
Bleeding And Diverticulitis Are The Key Complications
- Two main complications are diverticular bleeding (hematochezia) and diverticulitis.
- Fewer than 25% with diverticulosis will have GI bleeding, though bleeding risk rises with hypertension, atherosclerosis, anticoagulants, NSAIDs, obesity, and diabetes.
