What is the treatment for diverticulitis symptoms (s/s)?

Treatment of Diverticulitis

The treatment of diverticulitis should be stratified based on disease severity, with uncomplicated diverticulitis managed conservatively with observation and pain control (typically acetaminophen) while reserving antibiotics for complicated cases or patients with specific risk factors. 1, 2

Diagnosis

• Typical presentation includes:

  • Left lower quadrant abdominal pain
  • Fever
  • Change in bowel habits
  • Nausea
  • Elevated inflammatory markers (WBC, CRP)

• CT scan with IV contrast is the gold standard diagnostic test (98% sensitivity, 99% specificity) 1

• Clinical suspicion alone is correct in only 40-65% of cases, necessitating imaging confirmation 1

Treatment Algorithm

Uncomplicated Diverticulitis (85% of cases)

1. Conservative management:

   • Observation with pain management (acetaminophen preferred)
   • Clear liquid diet initially, advancing as tolerated
   • No routine antibiotics needed 2

2. Antibiotics indicated only if:

   • Persistent fever or chills
   • Increasing leukocytosis
   • Age >80 years
   • Pregnancy
   • Immunocompromised status
   • Chronic medical conditions (cirrhosis, CKD, heart failure, poorly controlled diabetes) 2

3. Antibiotic regimens when indicated:

   • Oral: amoxicillin-clavulanate OR cefalexin with metronidazole
   • IV (if unable to tolerate oral): ceftriaxone plus metronidazole OR ampicillin/sulbactam 1, 2
   • Duration: typically 7-10 days, individualized based on clinical response 1

Complicated Diverticulitis

1. Intravenous antibiotics:

   • Ceftriaxone plus metronidazole
   • Piperacillin-tazobactam
   • Ampicillin/sulbactam 1, 2

2. Abscess management:

   • Small abscesses (<4-5 cm): antibiotic therapy alone
   • Large abscesses (≥4-5 cm): percutaneous drainage plus antibiotics 1

3. Surgical intervention indicated for:

   • Peritonitis
   • Large undrainable abscesses
   • Fistula
   • Obstruction
   • Perforation with pneumoperitoneum 1, 2

Follow-up and Monitoring

• Colonoscopy recommended 4-6 weeks after resolution of complicated diverticulitis to rule out malignancy 1
• Monitor for treatment failure (persistent symptoms or worsening clinical condition)
• Approximately 5% of patients experience persistent abdominal pain with continued inflammation on CT 1

Prevention Strategies

• High-fiber diet (fruits, vegetables, whole grains, legumes)
• Regular physical activity
• Smoking cessation
• Avoidance of regular NSAID, opiate, and corticosteroid use 1

Important Caveats

• Elderly patients often present atypically, with only 50% having typical lower quadrant pain 1
• Perforated colon cancer can mimic both clinical and radiographic findings of diverticulitis 3
• CT findings suggesting cancer rather than diverticulitis include pericolonic lymphadenopathy >1 cm in short axis 3
• Patients discharged without antibiotics need clear instructions on when to seek medical attention (worsening pain, persistent fever, inability to tolerate oral intake, etc.) 1

The approach to diverticulitis has evolved significantly, with a trend toward more conservative management for uncomplicated cases, recognizing that antibiotics do not accelerate recovery or prevent complications in mild disease 4.