Acute Diverticulitis
General Overview
General Overview
- 85% in descending colon and sigmoid colon. Diverticula in ascending colon is more common in Asian populations
Risk factors:
Risk factors:
- Use of Aspirin and NSAIDs
- Older age
- Obesity
- Lack of exercise
Imaging if unclear diagnosis or suspected complications:
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):
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
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:
Complications:
- Abscess (CT guided percutaneous drainage)
- Bleeding
- Perforation
- Fistula
- Obstruction
Prevention of recurrences:
Prevention of recurrences:
- Increase dietary fibers
- Smoking cessation
- Regular exercise
- Weight loss if BMI > 30
Reference:
- AAFP 2013. http://www.aafp.org/afp/2013/0501/p612.html