Diverticular disease / Diverticulitis

Question 1

Triad

Answer 1

Acute Abdo pain (LIF)

Left sided radiation

Fever

+/- tenderness, guarding, rigidity in LIF

Question 2

Features

Answer 2

Diverticular disease is a problem of the colon

• 90% in descending colon

and is related to lack of fibre in the diet.

It is usually symptomless.

Question 3

Clinical features

Answer 3

Typical in middle aged or elderly >40 yrs

Diverticulosis—symptomless

Diverticulitis—infected diverticula and symptomatic constipation or alternating constipation/diarrhoea

• –intermittent cramping lower abdominal pain in LIF
• –tenderness in LIF
• –rectal bleeding may be profuse (± faeces)
• –may present as acute abdomen or subacute obstruction
• –usually settles in 2–3 d

Question 4

Investigations

Answer 4

WBC and ESR—to determine inflammation

Sigmoidoscopy

Barium enema

US/CT scan (acute disease)

Question 5

Management

Answer 5

High fibre diet

Symptomatic

• Fibre supplements
• Antispasmodics

Diverticulitis (mild)

• Amoxycillin + clavulanate 875 mg (o) bd, 5–10 d

Diverticulitis (complicated)

• Nil orally, IV fluids, analgesics
• (Amoxy) ampicillin IV + gentamicin IV + metronidazole IV