From the Guidelines
The workup for diverticulitis begins with a thorough history and physical examination, focusing on abdominal pain, fever, and changes in bowel habits, and should include abdominal CT imaging when there is diagnostic uncertainty, as recommended by the American College of Physicians 1. The initial steps in diagnosing acute colonic diverticulitis include a detailed history, physical examination, and laboratory findings, with CT imaging used to complement these findings when diagnostic uncertainty remains.
- Key laboratory tests should include complete blood count to assess for leukocytosis, C-reactive protein, and basic metabolic panel.
- Imaging is essential, with CT scan of the abdomen and pelvis with IV contrast being the gold standard as it can identify complications like abscess or perforation.
- For uncomplicated diverticulitis (no perforation, abscess, or peritonitis), outpatient management may not require antibiotics in select patients, as suggested by the American College of Physicians 1 and the American Gastroenterological Association 1.
- However, antibiotics such as amoxicillin-clavulanate or ciprofloxacin plus metronidazole may be considered in patients with comorbidities, refractory symptoms, or elevated C-reactive protein levels, as recommended by the American Gastroenterological Association 1.
- Patients should follow a clear liquid diet initially, gradually advancing as symptoms improve.
- For complicated diverticulitis, hospitalization is necessary with IV antibiotics, bowel rest, and possibly percutaneous drainage for abscesses larger than 4 cm, as suggested by the World Journal of Emergency Surgery 1.
- Surgical intervention may be required for perforation with peritonitis, obstruction, or fistula formation.
- After recovery, patients should gradually increase fiber intake to 25-35 g daily and maintain adequate hydration to prevent recurrence, and regular physical activity and maintaining healthy weight are also recommended as preventive measures.
- Immunocompromised patients are at higher risk for complications and should be treated with antibiotics and considered for consultation with a colorectal surgeon, as recommended by the American Gastroenterological Association 1.
From the Research
Workup for Diverticulitis
- The workup for diverticulitis typically involves a medical history, physical examination, and abdominopelvic computed tomography (CT) scanning 2, 3, 4
- The diagnosis of uncomplicated acute diverticulitis is based on these findings, and patients with severe or complicated diverticulitis may require additional testing and evaluation
Treatment for Uncomplicated Diverticulitis
- Most cases of diverticular inflammation are mild and require only medical treatment with a liquid diet and antibiotics 2, 3, 5
- Outpatient treatment with oral antibiotics, such as metronidazole and ciprofloxacin, has been shown to be safe and effective in treating uncomplicated diverticulitis 2, 3, 4
- Treatment typically consists of oral antibiotics for 7-10 days, a liquid diet, and oral analgesics 2, 3, 4
- Patients with uncomplicated diverticulitis can be treated on an outpatient basis, with a success rate of over 92% 2 and 95% 3
Treatment Duration and Recurrence
- Short-term intravenous antibiotic treatment in uncomplicated diverticulitis does not increase the risk of recurrence compared to long-term treatment 6
- The recurrence-free survival time is similar between patients receiving short-course and long-course IV antibiotic treatment 6
- Treatment failure is rare, and most patients can be successfully treated with outpatient treatment 2, 3, 4