From the Guidelines
Diverticulitis symptoms can be classified into uncomplicated and complicated categories, with uncomplicated diverticulitis involving thickening of the colon wall and peri-colonic inflammatory changes, and complicated diverticulitis including the presence of abscess, peritonitis, obstruction, stricture and/or fistula 1.
Classification of Diverticulitis Symptoms
The classification of diverticulitis symptoms is crucial for determining the appropriate treatment approach. According to the American Gastroenterological Association (AGA) Clinical Practice Update, diverticulitis can be categorized into two main types: uncomplicated and complicated 1.
- Uncomplicated diverticulitis typically presents with symptoms such as left lower quadrant abdominal pain, low-grade fever, and changes in bowel habits like constipation or diarrhea.
- Complicated diverticulitis, on the other hand, involves more serious symptoms including high fever, severe abdominal pain, peritonitis, abscess formation, bowel obstruction, or perforation.
Importance of Classification
The classification of diverticulitis symptoms is essential for guiding treatment decisions. Mild cases of diverticulitis can often be managed with oral antibiotics and a temporary liquid diet, while severe cases require hospitalization, intravenous antibiotics, bowel rest, and possibly surgical intervention 1.
Treatment Approach
The treatment approach for diverticulitis depends on the severity of symptoms and potential complications. For uncomplicated diverticulitis, oral antibiotics such as ciprofloxacin and metronidazole may be prescribed for 7-10 days, along with a temporary liquid diet 1. For complicated diverticulitis, hospitalization and intravenous antibiotics may be necessary, and surgical intervention may be required in some cases. The classification system helps clinicians determine the appropriate level of care and intervention needed based on symptom severity and potential complications 1.
From the Research
Diverticulitis Classification and Symptoms
- Diverticulitis can be classified as uncomplicated or complicated based on CT scan, severity of symptoms, and patient history 2, 3.
- Uncomplicated diverticulitis is characterized by localized diverticular inflammation, whereas complicated diverticulitis is associated with an abscess, phlegmon, fistula, obstruction, bleeding, or perforation 3.
- Symptoms of diverticulitis may include left lower quadrant pain, tenderness, abdominal distention, fever, anorexia, constipation, nausea, diarrhea, and dysuria 3, 4.
Diagnosis and Management
- Computed tomography (CT) is useful in establishing the diagnosis and extent of disease, and excluding complications in selected patients 2, 3, 4.
- Colonoscopy is recommended for patients with complicated diverticulitis or for those who meet national bowel cancer screening criteria 2, 3.
- Outpatient treatment with oral antibiotics may be suitable for patients with uncomplicated diverticulitis who are afebrile, clinically stable, and have adequate family support 5, 6.
- Hospitalization is indicated for patients with signs of peritonitis, suspicion of complicated diverticulitis, or those who require intravenous antibiotics 3, 6.
Treatment Options
- Antibiotics may not be necessary for patients with uncomplicated diverticulitis, but may be beneficial in selected cases 2, 3, 6.
- Rifaximin has been shown to be effective in obtaining symptom relief and improving symptoms in patients with uncomplicated diverticular disease 6.
- Surgical intervention may be necessary for patients with complicated diverticulitis, peritonitis, or those who fail non-operative management 2, 3.