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