What is the clinical significance of colonic redundancy with retained fecal material and no evidence of acute diverticulitis (inflammation of the diverticula)?

From the Guidelines

Colonoscopy should be considered if alarm symptoms are present, but otherwise, it should be delayed by 6–8 weeks or until complete resolution of acute symptoms, whichever is longer, according to the AGA clinical practice update on medical management of colonic diverticulitis 1. Given the CT findings of colonic redundancy with moderate retained fecal material and no convincing evidence of acute diverticulitis, the initial approach should focus on managing symptoms and preventing complications.

• Conservative management is recommended, including:
  • Increased fluid intake (at least 2-3 liters daily)
  • A high-fiber diet (25-30 grams daily)
  • Regular physical activity to improve bowel motility
• Over-the-counter stool softeners like docusate sodium (100mg twice daily) or a gentle osmotic laxative such as MiraLAX (17g in 8oz water daily) may help clear the retained stool. The decision to proceed with colonoscopy should be based on the presence of alarm symptoms, such as change in stool caliber, iron deficiency anemia, blood in stool, weight loss, or abdominal pain, as outlined in the AGA clinical practice update 1. If symptoms persist or worsen, a GI consultation for potential colonoscopy may be considered to evaluate the redundant colon and rule out any obstructive lesions, taking into account the patient's history, most recent colonoscopy, and course of the disease 1.

From the Research

Colonic Redundancy and Retained Fecal Material

• The presence of colonic redundancy with a moderate amount of retained fecal material in the redundant colon may be associated with functional bowel disorders, as suggested by a study published in the Danish medical journal 2.
• This study found that faecal retention in the colon is a causative factor in functional bowel disease, appendicitis, and haemorrhoids, and that measuring colon transit time (CTT) and faecal load can be a guide to a positive functional diagnosis of bowel disorders.
• Another study published in Diseases of the esophagus found that colonic redundancy is a common late complication following esophageal replacement by colonic interposition, and that surgical correction may be necessary to improve quality of life and prevent complications 3.

Potential Symptoms and Complications

• Patients with colonic redundancy and retained fecal material may experience symptoms such as abdominal bloating, abdominal pain, and defecation disorders, as reported in the study published in the Danish medical journal 2.
• If left untreated, colonic redundancy and retained fecal material may lead to complications such as acute diverticulitis, although there is no convincing CT evidence of this condition in the present case.
• A study published in BMJ clinical evidence found that diverticula are rare before the age of 40 years, but prevalence increases steadily with age, and that only 10% to 25% of affected people will develop symptoms such as lower abdominal pain 4.

Management and Treatment

• If persistent or worsening symptoms occur, a GI medicine consultation for potential colonoscopy may be considered, as this may clinically affect patient management.
• A study published in Clinical therapeutics found that diet plays an important role in common benign colorectal diseases, and that a diet rich in fibre and regular physical activity have a therapeutic and preventive effect on colorectal diseases associated with faecal retention 5.
• Another study published in Mayo Clinic proceedings found that the approach to treatment of microscopic colitis, a condition that may be associated with colonic redundancy and retained fecal material, should be guided by the severity of the patient's symptoms, and that offending medications should be eliminated as clinically possible 6.