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Diverticulosis is a common condition in the Western world, affecting 35-50% of people over 60. 1 2 Few of those affected are symptomatic, possibly only about 5%. Of those with symptoms, most can be treated medically, and only 7% of symptomatic individuals ultimately require surgery. Mortality from the disease is in the order of 2%, death usually following emergency surgery. 3
Crohn's disease of the colon has an estimated incidence of about 1.5-3.6 per 100 000. 4 The sigmoid colon is involved in about 70% of these cases, 3 with involvement of the distal colon and anorectum being more common in older age groups. 5 Both Crohn's colitis and diverticulitis are seen with sufficient frequency that unless one disease protects from the other, one would occasionally expect to see coincident disease. Early reports suggested that combined disease carried a worse prognosis than either disease in isolation, and advocated more aggressive treatment. 6 7 However, it is increasingly apparent that diverticulosis may be accompanied by inflammatory changes that mimic inflammatory bowel disease, 8 9 and that caution should be exercised in making a diagnosis of Crohn's disease in the presence of diverticulosis. We have reviewed all individuals coming to surgery in one hospital over a 20 year period, in whom there was a histopathological diagnosis of both Crohn's disease and diverticulitis.
Study group
The files of the Department of Histopathology of the General Infirmary at Leeds were searched for specimens coded for both Crohn's disease and diverticulosis or diverticulitis. Over a 20 year period (1968-1988), 11 cases were identified in which histological features of both Crohn's disease and diverticulosis were confirmed. The case notes of these patients were reviewed, with further follow up obtained from general practitioners in some cases.
Table 1 summarises the clinical details. The age of patients ranged from 45 to 82 years. There was a preponderance of older individuals and of women, both characteristic of diverticular disease rather than Crohn's disease. All presented with diarrhoea, most also complaining of pain and rectal bleeding. The time interval between presentation and surgery was variable, the longest being four years (median one year). Patient 1 had a 16 year history of ulcerative colitis, treated with steroids, but presented with new symptoms. Patient 2 had...