From the Guidelines
Diverticulitis flare symptoms typically include persistent pain in the lower left abdomen, which may be severe and worsen with movement, and treatment usually involves antibiotics and a temporary liquid or low-fiber diet until symptoms improve.
Symptoms of Diverticulitis
- Persistent pain in the lower left abdomen
- Fever
- Nausea
- Vomiting
- Constipation or diarrhea
- Bloating
- Blood in stool
Diagnosis and Treatment
According to the American College of Physicians guideline 1, abdominal CT imaging is recommended when there is diagnostic uncertainty in a patient with suspected acute left-sided colonic diverticulitis. Treatment for diverticulitis usually involves antibiotics, such as ciprofloxacin and metronidazole, for 7-10 days, along with a temporary liquid or low-fiber diet until symptoms improve 1. For severe cases, hospitalization may be necessary for intravenous antibiotics and bowel rest.
Prevention of Future Flares
To prevent future flares, it is recommended to:
- Maintain a high-fiber diet (25-30g daily)
- Stay well-hydrated
- Exercise regularly
- Avoid constipation once the acute episode resolves
Special Considerations
For immunocompromised patients, such as those with chronic kidney disease or on chronic steroid medication, elective sigmoidectomy may be considered after a successfully treated episode of acute uncomplicated diverticulitis 1. In transplanted patients, elective sigmoidectomy may be proposed after the first episode of acute diverticulitis, given the high morbidity and mortality rate when emergency surgery is required 1.
Note: The above recommendations are based on the most recent and highest quality studies available, including the American College of Physicians guideline 1 and other relevant studies 1.
From the Research
Diverticulitis Flare Symptoms
The symptoms of diverticulitis flare can vary, but common symptoms include:
- Left lower quadrant pain
- Abdominal distention or rigidity
- Fever
- Leukocytosis
- Anorexia
- Constipation
- Nausea
- Diarrhea
- Dysuria 2, 3, 4, 5
Diagnosis and Classification
Diverticulitis can be diagnosed using computed tomography (CT) scans, which can also help classify the disease as complicated or uncomplicated 2, 3, 4, 5.
- Uncomplicated diverticulitis is characterized by inflammation limited to the colonic wall and surrounding tissue
- Complicated diverticulitis is defined as diverticulitis associated with localized or generalized perforation, localized or distant abscess, fistula, stricture, or obstruction 3, 5
Treatment Options
Treatment options for diverticulitis flare depend on the severity of the disease and can include:
- Outpatient treatment with antibiotics for uncomplicated diverticulitis
- Hospitalization and intravenous antibiotics for complicated diverticulitis
- Percutaneous drainage for abscesses
- Surgery for severe cases or when other treatments fail 2, 3, 4, 6, 5
Prevention Measures
Prevention measures for diverticulitis flare include: