From the Guidelines
Transverse colon diverticulitis is primarily caused by inflammation of small pouches (diverticula) that form in the wall of the transverse colon, and its treatment should be guided by the severity of the condition, with a focus on selective use of antibiotics, as recommended by recent guidelines 1. The main causes of transverse colon diverticulitis include:
- Low-fiber diet
- Obesity
- Physical inactivity
- Smoking
- Aging
- Genetic factors
- Certain medications like NSAIDs
Treatment of transverse colon diverticulitis depends on the severity of the condition. For mild to moderate cases, outpatient management may be sufficient, including:
- Clear liquids or low-residue diet for 2-3 days
- Oral antibiotics, such as amoxicillin-clavulanate 875/125 mg twice daily, or ciprofloxacin 500 mg plus metronidazole 500 mg, both twice daily for 7-10 days, although recent guidelines suggest that antibiotics can be used selectively, rather than routinely, in immunocompetent patients with mild uncomplicated diverticulitis 1
- Pain management with acetaminophen
Severe cases, however, require hospitalization for:
- IV antibiotics, such as ceftriaxone 1-2g daily plus metronidazole 500 mg every 8 hours
- Bowel rest
- IV fluids
Complications like abscess, perforation, or obstruction may require surgical intervention, ranging from drainage procedures to colon resection. After recovery, patients should:
- Gradually increase dietary fiber to 25-35g daily
- Stay well-hydrated
- Exercise regularly
- Avoid NSAIDs
- Quit smoking to prevent recurrence
The inflammation occurs when fecal matter gets trapped in these pouches, allowing bacteria to multiply and cause infection, which explains why dietary modifications and antibiotics form the cornerstone of treatment. Recent guidelines also recommend that patients with uncomplicated diverticulitis who have comorbidities or are frail, who present with refractory symptoms or vomiting, or who have a CRP >140 mg/L or baseline white blood cell count > 15 × 10^9 cells per liter should be treated with antibiotics 1.
From the Research
Causes of Transverse Colon Diverticulitis
- Low-residue diet and increased intraluminal pressure are considered to be etiologic factors of diverticulitis 2
- Western food and age are also contributing factors to the prevalence of colonic diverticula 2
- Genetic alterations, chronic low-grade inflammation, and gut dysbiosis are also thought to play a role in the pathophysiology of diverticulosis and diverticular disease 3
Treatment of Transverse Colon Diverticulitis
- For uncomplicated diverticulitis, the standard therapy is liquid diet and oral antimicrobials, usually ciprofloxacin and metronidazole 4
- Hospitalization, bowel rest, and intravenous antibacterial agents are mandatory for complicated diverticulitis 4
- Fiber supplementation, such as soluble fiber like glucomannan, and poorly absorbed antibiotics, like rifaximin, can help prevent acute diverticulitis and improve symptoms 4
- Surgery may be necessary in cases of diffuse peritonitis, abscesses, fistulas, stenosis, and after the second to fourth attack of uncomplicated diverticulitis 4, 2
- Mesalazine, probiotics, and anti-inflammatory drugs may also be used in the treatment of diverticulitis, alone or in combination with antibiotics 3, 5