Acute Diverticulitis

Background

• Inflammation and/or infection of a diverticulum, a small out-pouching along wall of colon
• Ddx: (see approach to abdominal pain)
• Presence of colonic flora on Urine culture suggests colo-vesical fistula
• Most pts w/ uncomplicated diverticulitis have significant improvement 2-3 d after IV abx

Presentation

• Lower abdominal pain (85% LLQ), tenderness to palpation on exam, N/V, low-grade fever, change in bowel habits (constipation or diarrhea)

Evaluation

• CBC w/diff, CMP, Lipase, U/A, β - hCG
• Imaging: CT abdomen/pelvis with oral and IV contrast
  • • CT findings: localized bowel wall thickening (>4mm), paracolic fat stranding, presence of colonic diverticula

Management

• IVF, pain control
• Bowel rest vs. clear liquids (advance diet as tolerated)
• IV antibiotics: should cover GNRs and anaerobic organisms
  • • Zosyn, cefepime + metronidazole, or meropenem (if high risk for organisms w/ESBL)
• Continue IV abx until abdominal pain/tenderness is resolved (usually 3-5 days), then transition to oral: cipro + metronidazole or Augmentin to complete 10-14 d course
• Criteria for discharge:
  • • Resolution of vital sign abnormalities (fever, tachycardia, hypotension)
    • Resolution of severe abdominal pain
    • Improvement of leukocytosis
    • Able to tolerate oral diet
• Colonoscopy after complete resolution of symptoms (6 – 8 weeks) to definitively rule out presence of underlying colorectal cancer (unless performed in last year)