What is the recommended treatment for a patient with uncomplicated diverticulosis diagnosed via computed tomography (CT) abdomen and pelvis without contrast due to an allergy to contrast dye?

Management of Uncomplicated Diverticulosis

For a patient with uncomplicated diverticulosis diagnosed on CT scan, no treatment is required—this is an incidental finding that warrants lifestyle modifications only, not antibiotics or medical intervention. 1

Critical Distinction: Diverticulosis vs. Diverticulitis

• Diverticulosis is simply the presence of colonic outpouchings without inflammation—this patient has diverticulosis, NOT diverticulitis 1
• Diverticulosis is asymptomatic and requires no acute treatment 1
• Only 1-4% of patients with diverticulosis will ever develop acute diverticulitis in their lifetime 2
• The CT finding of "uncomplicated diverticulosis" means there is no inflammation, no abscess, no perforation, and no clinical signs of infection 1

Recommended Management Approach

Immediate Management

• No antibiotics are indicated for diverticulosis—antibiotics are only used for diverticulitis (inflammation), not for the mere presence of diverticula 1, 2
• No hospitalization required 1
• No dietary restrictions during this asymptomatic phase 1

Long-Term Prevention Strategy

Dietary Modifications:

• Adopt a high-quality diet rich in fiber from fruits, vegetables, whole grains, and legumes, with fiber intake exceeding 22.1 g/day for protective effect 1
• Reduce consumption of red meat and sweets 1
• Do NOT restrict nuts, corn, popcorn, or small-seeded fruits—these are not associated with increased risk of diverticulitis despite common misconceptions 1

Lifestyle Modifications:

• Engage in regular vigorous physical activity to decrease risk of progression to diverticulitis 1
• Achieve or maintain normal body mass index 1
• Avoid smoking 1
• Avoid regular use of NSAIDs and opiates when possible, as these increase diverticulitis risk 1

When to Seek Medical Attention

Instruct the patient to return immediately if they develop symptoms of diverticulitis:

• Left lower quadrant abdominal pain 2
• Fever or chills 2
• Nausea or vomiting 2
• Change in bowel habits 1

Common Pitfalls to Avoid

• Do not prescribe antibiotics for asymptomatic diverticulosis—this represents overtreatment and contributes to antibiotic resistance 1
• Do not recommend unnecessary dietary restrictions (avoiding nuts, seeds, popcorn) as these are not evidence-based 1
• Do not prescribe mesalamine or rifaximin for prevention—these have no role in diverticulosis management 1
• Do not assume fiber supplements alone are sufficient—they should complement, not replace, a high-quality diet 1

Follow-Up Considerations

• No routine imaging follow-up is needed for uncomplicated diverticulosis 1
• Colonoscopy should follow standard colorectal cancer screening guidelines based on age and risk factors, not based on the presence of diverticulosis alone 1
• Approximately 50% of diverticulosis risk is attributable to genetic factors, so family history should be documented 1