“Wayside Houses of Ill-Repute” – Diverticular Disease of the Colon

Abstract

A diverticulum is simply a blind pouch and it can occur in any section of the alimentary tract; this article concentrates on those arising from the large bowel.

The question of how diverticulae are produced was for many years the subject of pure conjecture rather than of scientific proof. If we turn back the pages of medical journals over the past century, we see many shifts in the emphasis of man’s efforts to elucidate the cause of acquired colonic diverticular disease. The current theory is that abnormal inter-haustral contractions of rings of thickened muscle result in the development of very high intra-colonic pressures in response to certain specific stimuli, the most important being morphine and prostigmine. By contrast, “probanthine” and atropine tend to abolish the pressures.

I must stress that basal pressures are similar in patients with diverticular disease and in normal controls. (This tends to refute any close casual relationship between the “spastic colon" and diverticular disease.) It is only in response to certain stimuli that the abnormal intraluminal pressures may be recorded.

One important practical point is that the above facts represent prima facie evidence against using morphine to alleviate the pain of acute diverticulitis.