Published online Sep 28, 2016. doi: 10.3748/wjg.v22.i36.8067
Peer-review started: May 30, 2016
First decision: July 12, 2016
Revised: July 21, 2016
Accepted: August 23, 2016
Article in press: August 23, 2016
Published online: September 28, 2016
Segmental colitis associated diverticulosis (SCAD) has become increasingly appreciated as a form of inflammatory disease of the colon. Several features suggest that SCAD is a distinct disorder. SCAD tends to develop almost exclusively in older adults, predominately, but not exclusively, males. The inflammatory process occurs mainly in the sigmoid colon, and usually remains localized to this region of the colon alone. SCAD most often presents with rectal bleeding and subsequent endoscopic visualization reveals a well localized process with non-specific histopathologic inflammatory changes. Granulomas are not seen, and if present, may be helpful in definition of other disorders such as Crohn’s disease of the colon, an entity often confused with SCAD. Bacteriologic and parasitic studies for an infectious agent are negative. Normal rectal mucosa (i.e., “rectal sparing”) is present and can be confirmed with normal rectal biopsies. SCAD often resolves spontaneously without treatment, or completely after a limited course of therapy with only a 5-aminosalicylate. Recurrent episodes may occur, but most often, patients with this disorder have an entirely self-limited clinical course. Occasionally, treatment with other agents, including corticosteroids, or surgical resection has been required.
Core tip: Segmental colitis associated diverticulosis is an increasingly recognized inflammatory disorder involving the colon, particularly the sigmoid colon. The disorder occurs mainly in males, often presents with rectal bleeding, and endoscopic evaluation usually reveals a localized non-granulomatous process in the sigmoid colon, frequently with rectal sparing. The clinical course is generally self-limited, sometimes resolving spontaneously or responding to minimal treatment.