From the Guidelines
The workup for diverticulitis should include a thorough history and physical examination, laboratory tests, and imaging studies, with abdominal CT imaging being the preferred method for diagnosis when there is diagnostic uncertainty 1. The initial evaluation should focus on complete blood count to assess for leukocytosis, basic metabolic panel to evaluate kidney function, and urinalysis to rule out urinary tract infection. C-reactive protein may help gauge inflammation severity. Some key points to consider in the workup and management of diverticulitis include:
- Imaging is essential, with CT scan of the abdomen and pelvis with IV contrast being the gold standard as it can identify diverticular inflammation, abscess formation, and potential complications like perforation 1.
- Ultrasound may be used in pregnant patients or those who cannot undergo CT.
- For mild, uncomplicated diverticulitis, outpatient management with oral antibiotics (typically amoxicillin-clavulanate 875/125 mg twice daily or ciprofloxacin 500 mg twice daily plus metronidazole 500 mg three times daily for 7-10 days) is appropriate, although antibiotics may not be necessary in select patients without systemic inflammatory response or immunosuppression 1.
- Patients should follow a clear liquid diet initially, advancing as tolerated.
- Complicated diverticulitis with abscess, perforation, obstruction, or peritonitis requires hospitalization, IV antibiotics (such as piperacillin-tazobactam 3.375 g every 6 hours or ceftriaxone 1-2 g daily plus metronidazole 500 mg every 8 hours), bowel rest, and possible surgical intervention.
- Percutaneous drainage may be needed for abscesses larger than 4-5 cm.
- Follow-up colonoscopy is recommended 6-8 weeks after resolution to exclude malignancy, particularly for first-time episodes or those over 50 who haven't had recent screening.
From the Research
Diverticulitis Workup
- The diagnosis of diverticulitis is typically made using computed tomography (CT) scans, which can help establish the extent and severity of the disease 2.
- Initial laboratory studies for diverticulitis may include a complete blood count, basic metabolic panel, urinalysis, and measurement of C-reactive protein 2.
- Patients with acute diverticulitis may present with symptoms such as left lower quadrant pain, tenderness, abdominal distention, and fever, as well as other symptoms like anorexia, constipation, nausea, diarrhea, and dysuria 2.
Classification and Management
- Diverticulitis can be classified as uncomplicated or complicated, based on the presence of complications such as abscesses, perforation, or peritonitis 2, 3.
- Uncomplicated diverticulitis can often be managed on an outpatient basis with selective use of antibiotics, while complicated diverticulitis may require hospitalization and more aggressive treatment 2, 3.
- The use of antibiotics in uncomplicated diverticulitis is uncertain, with some studies suggesting that they may not be necessary for all patients 4, 5.
Imaging and Diagnostic Tests
- CT scans are the most commonly used imaging test for diagnosing diverticulitis, and can help identify complications such as abscesses or perforation 2, 3.
- Colonoscopy may be recommended for patients with complicated diverticulitis or for those who have suspicious features on CT scan or meet national bowel cancer screening criteria 2, 3.
Treatment Options
- Treatment for diverticulitis may include bowel rest, intravenous antibiotics, and pain management, as well as surgical intervention in some cases 2, 3.
- The choice of antibiotic regimen may depend on the severity of the disease and the presence of complications, with some studies suggesting that amoxicillin-clavulanate may be a suitable alternative to fluoroquinolone-based regimens 5.