Intramural diverticulosis and diverticulitis of the colon: Pictorial essay

Published:November 02, 2021DOI:


      • Intramural diverticulosis is the initial manifestation of a common colonic disorder.
      • It often develops in adults younger than 40 years in age.
      • It appears as 1-2 mm mucosal pockets protruding in to the colonic wall.
      • It represents a potential site for intramural diverticulitis.
      • These lesions can be diagnosed by barium enema or CT.


      Diverticulosis of the colon is a gradually progressive disease that usually starts in early adulthood and increases with advancing age in its anatomical extent and the size of diverticula. It is important to recognize the initial stages of diverticular development in young patients in order to properly diagnose and manage the potential complications of this very common intestinal disorder. This article presents the pathological and radiological features of early diverticular formation, when the mucosal outpouchings are very small and contained within the colonic wall as distinct intramural lesions. The subsequent development of intramural diverticulitis and the spectrum of its manifestations on barium enema examination or Computed tomography (CT) are illustrated.


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        • Tursi A.
        Diverticulosis today: unfashionable and still under-researched.
        Therap Adv Gastroenterol. 2016; 9: 213-228
        • Thakrar K.H.
        • Gore R.M.
        • Yaghmai V.
        • Balthazar E.J.
        Diverticular disease of the colon.
        in: Gore R.M. Levine M.S. Textbook of gastrointestinal radiology. Elsevier Saunders Company, Philadelphia, PA2015: 934-954
        • Matrana M.R.
        • Margolin D.A.
        Epidemiology and pathophysiology of diverticular disease.
        Clin Colon Rectal Surg. 2009; 22: 141-146
        • Zaidi E.
        • Daly B.
        CT and clinical features of acute diverticulitis in an urban US population: rising frequency in young obese adults.
        . 2006; 187: 689-694
        • Wijarnpreecha K.
        • Ahuja W.
        • Chesdachai S.
        • et al.
        Obesity and risk of colonic diverticulosis: a meta-analysis.
        Dis Colon Rectum. 2018; 61: 476-483
        • Wiesner W.
        • Mortele K.J.
        • Ji H.
        • Ros P.R.
        Normal colonic wall thickness at CT and its relation to colonic distension.
        J Comput Assist Tomogr. 2002; 26: 102-106
        • Desai R.K.
        • Tagliabue J.R.
        • Wegryn S.A.
        • Einstein D.M.
        CT evaluation of wall thickening in the alimentary tract.
        Radiographics. 1991; 11: 771-783
        • Macari M.
        • Balthazar E.J.
        CT of bowel wall thickening: significance and pitfalls of interpretation.
        . 2001; 176: 1105-1116
        • Lane J.S.
        • Sarkar R.
        • Schmit P.J.
        • et al.
        Surgical approach to cecal diverticulitis.
        J Am Coll Surg. 1999; 188: 629-634
        • Heise C.P.
        Epidemiology and pathogenesis of diverticular disease.
        J Gastrointest Surg. 2008; 12: 1309-1311
        • DeStigler K.K.
        • Keating D.P.
        Imaging update: acute colonic diverticulitis.
        Clin Colon Rectal Surg. 2009; 22: 147-155
        • Marinella M.A.
        • Mustafa M.
        Acute diverticulitis in patients 40 years of age or younger.
        Am J Emerg Med. 2000; 18: 140-142
        • Pautrat K.
        • Bretagnol F.
        • Huten N.
        • De Clan L.
        Acute diverticulitis in very young patients: a frequent surgical management.
        Dis Colon Rectum. 2007; 50: 472-477
        • Minardi A.J.
        • Johnson L.W.
        • Sehon J.K.
        • et al.
        Diverticulitis in the young patient.
        Am Surg. 2001; 67: 458-461
        • Lahat A.
        • Menachem Y.
        • Avidan B.
        • et al.
        Diverticulitis in the young patient-is it different.
        World J Gastroenterol. 2006; 12: 2932-2935
        • Razik R.
        • Chong C.A.
        • Nguyen G.C.
        Younger age and prognosis in diverticulitis: a nationwide retrospective cohort study.
        Can J Gastroenterol. 2013; 27: 95-98
        • Cohen S.E.
        • Cunningham J.R.
        • Sneierson H.
        The intramural diverticulum and dissecting diverticulitis.
        AMA Arch Surg. 1957; 75: 800-806
        • Beachley M.C.
        Intramural masses secondary to diverticular disease of the colon.
        . 1972; 115: 368-371
        • Levine M.S.
        • Moolten D.N.
        • Herlinger H.
        • Laufer I.
        Esophageal intramural pseudodiverticulosis: a reevaluation.
        . 1986; 147: 1165-1170
        • Ross W.D.
        • Finby N.
        • Evans J.A.
        Intramural diverticulosis of the gallbladder; Rokitanski-Aschoff sinuses.
        Radiology. 1955; 64: 366-372