Acute Diverticulitis

General Overview

  • 85% in descending colon and sigmoid colon. Diverticula in ascending colon is more common in Asian populations

Risk factors:

  • Use of Aspirin and NSAIDs
  • Older age
  • Obesity
  • Lack of exercise

Imaging if unclear diagnosis or suspected complications:

  • CT abdomen with double contrast (PO and IV)
  • Colonoscopy is contraindicated in acute diverticulitis but patients should have a colonoscopy in 4-6 weeks after resolution to assess extent of diverticular disease and to r/o colon cancer

Treatment of mild uncomplicated diverticulitis (if mild symptoms, able to tolerate oral intake, and no signs of peritonitis):

  • Clear liquid and FU in 2-3 days
  • Consider broad spectrum oral antibiotics against gram-negative rods and anareobic bacteria
    • Septra DS 160/800mg po BID
    • Ciprofloxacin 500-750mg po BID + Metronidazole 500mg po Q6H for 7-10 days

Treatment of moderate to severe diverticulitis

  • Hospital admission
  • IVF
  • IV antibiotics with PipTazo 3.375g IV Q6H or 4.5g IV Q8H until resolution of symptoms then transition to 10-14 days of oral antibiotics
  • NPO
  • CT abdomen

Complications:

  • Abscess (CT guided percutaneous drainage)
  • Bleeding
  • Perforation
  • Fistula
  • Obstruction

Prevention of recurrences:

  • Increase dietary fibers
  • Smoking cessation
  • Regular exercise
  • Weight loss if BMI > 30