The high fibre diet in the treatment of diverticular disease of the colon.

Diverticular disease of the colon causes symptoms even in the absence of inflammatory diverticulitis. These symptoms vary from vague dyspepsia to severe colic which may lead to resection of the sigmoid for 'diverticulitis'. This paper discusses the use of a high fibre diet, including miller's bran, in the treatment of uncomplicated diverticulosis. In the majority of cases this diet relieves symptoms and lessens the need for surgery in diverticular disease. Definitions A colonic diverticulum is an acquired herniation of the mucosa through the surrounding colonic muscle. The colon's circular muscle forms a complete tube while its longitudinal muscle is gathered into three taeniae, between which the colonic wall is thinner and here it is further weakened by the blood vessels which pierce it. These form tunnels along which diverticula commonly track so that the vessels bear to diverticula the same relationship as the sper-matic cord does to an inguinal hernia (Drummond, 1917). As diverticula enlarge, their muscle covering atrophies so that they cannot contract and expel faeces which harden into faecoliths that can be felt at operation. Diverticula commonly occur in two rows on each side of the colon and less often on the antimesocolic border. This is because the lateral blood vessels are bigger and so most diverticula follow them and track into the fat of the appendices epiploicae (Slack, 1962). Hence diverticula are difficult to see at operation or at autopsy. This regular arrangement may be lost if recurrent inflammation distorts the colon's anatomy. The appearance of diverticulitis on the clinical scene Colonic diverticula were described very accurately over a hundred years ago They believed that the diverticula were caused by constipation which caused some form of obstruction. In this deduction they were surprisingly accurate, as it was not until a century later when cineradiography became available that it was shown that diverticula were caused by segmentation leading Diverticula were regarded as harmless curiosities until Graser (1899) pointed out that they might lead to peritonitis and other lethal complications. In the next decade, diverticulitis appeared on the clinical scene with dramatic suddenness. Telling first saw the disease in 1899 and could find no one who was familiar with it but, by 1908, he could describe all the complications and, in 1917, he wrote his classic paper with Gruner. The disease, which was so new that by 1920 it had not found its way into the textbooks (Telling, 1920) …