Treatment Guideline Chart
Diverticulitis is the inflammation of the diverticulum which is a herniation of the mucosa and submucosa of the colonic wall that may fill with fecal material or undigested food particles. 
Abdominal pain is usually localized, abrupt, steady and may worsen over time.
Other signs and symptoms are fever, anorexia, nausea without vomiting, and altered bowel movements, commonly constipation but may also present with diarrhea or tenesmus.

Diverticulitis Management

Clinical Decision

Decision to treat as outpatient versus inpatient will depend on clinical judgment of the physician, severity of the disease process, tolerance of oral intake, presence of comorbid illnesses, patient support system, and the probability that the condition will respond to outpatient therapy

Patients Receiving Outpatient Therapy

  • Reliability of patient and caregivers is an important consideration
  • Patient and caregiver should be advised that the patient should return to the emergency room or call physician if condition worsen 

Indications for Hospitalization of Patients with Uncomplicated Diverticulitis 

  • Unable to tolerate oral intake
  • Failure of outpatient management
  • Significant peritoneal signs are present
  • Patient needs narcotic analgesia for severe pain
  • A chronic underlying medical condition is present eg immunosuppression

Clinical Evaluation

Risk Factors for Progression of Uncomplicated Diverticulitis to Complicated Diverticulitis

  • Symptoms >5 days prior to presentation
  • Presence of vomiting
  • CRP level >140 mg/L
  • Baseline white blood cell (WBC) count >15 x 109 cells/L
  • Baseline CT with finding of fluid collection or longer segment of inflammation

Indications of Worsening Disease Requiring Hospitalization

  • Inability to tolerate oral fluids
  • Increase in temperature or high fever
  • Worsening abdominal pain

Follow Up

Re-evaluation of the patient should be done after resolution of an attack of acute diverticulitis 

  • Patient should be instructed to gradually resume a high-fiber diet
    • Long-term fiber supplementation may reduce recurrence of attacks
    • Bulk-forming laxatives may be given to patients who cannot tolerate high-fiber diet
  • Advise patients to avoid using NSAIDs or opioids
  • Appropriate exams 6 weeks after recovery include colonoscopy or a combination of flexible sigmoidoscopy and barium enema
    • Establishes extent of disease and rules out polyps or carcinoma
  • Diverticulitis may result in formation of strictures which may have a carcinoma-like appearance and may need to be biopsied
  • Surgery may be needed for recurrent attacks of diverticulitis
    • Elective surgery is not needed for patients responsive to medical treatment and not routinely recommended for either uncomplicated or complicated diverticulitis in young patients
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