Diverticulitis

Question 1

uncomplicated diverticulitis without significant comorbidities treatment:

Answer 1

Treat conservatively with oral antibiotics : ciprofloxacin + metronidazole or amoxicillin clavulanate

Question 2

uncomplicated diverticulitis with significant comorbidities or complicated diverticulitis

Answer 2

IV antibiotics
beta lactam/beta lactamase inhibitor (zosyn)

or

3rd generation cephalosporin (ceftriaxone) + metronidazole

OR
fluoroquinolone (ciprofloxacin) + metronidazole

Need to be on liquid diet for 2-3 days

Question 3

left lower quadrant pain/ tenderness, fever and leukocytosis

can have rectal mass

Answer 3

uncomplicated diverticulitis presentation

if convincing don’t need to get imaging.

If diagnosis is not clear or abscess is suspected (severe pain, high fever, palpable mass) then get CT imaging.

Question 4

CT scan of uncomplicated diverticulitis

Answer 4

soft tissue stranding and colonic wall thickening.

Question 5

treatment of uncomplicated diverculitis

Answer 5

7-10 days of abx with bowel rest (liquid diet for 2-3 days) and gradual transition from fluid intake to and close follow up

Question 6

when to hospitalize a pt with diverticulitis

Answer 6

high fever, significant leukocytosis, and immunosuppression and someone unable to tolerate oral intake and significant comorbidities

Question 7

complicated diverticulitis is defined as

Answer 7

abscess, perforation, obstruction, fistula formation. IV abx is needed

Question 8

when to order CT guided drainage in patient with complicated diverticulitis

Answer 8

need CT guided drainage in pts who have abscess >3cm from diverticulitis

Question 9

When to involve the surgeons for treatment of complicated diverticulitis

Answer 9

when clinical course worsens or not responding to catheter drainage.

Question 10

what is long term management for someone who has diverticulitis?

Answer 10

after they recover 2-6 weeks later, they need a sigmoidoscopy or colonoscopy to rule out underlying malignancy.

Question 11

what is an alternate strategy for colonoscopy after diverticulitis for colon cancer screening?

Answer 11

flexible sigmoidoscopy + barium enema

Question 12

what to do to prevent recurrence

Answer 12

possibly a high fiber diet to possible reduce risk for recurrence of diverticulitis

Question 13

do you always need to get CT abd imaging in pts who have suspected uncomplicated diverticulitis?

Answer 13

if convincing don’t need to get imaging.

If diagnosis is not clear or abscess is suspected (severe pain, high fever, palpable mass) then get CT imaging.

Question 14

IV abx is needed for diverticulitis if:

Answer 14

complicated diverticulitis (abscess or fistula formation - can form between bladder, vagina, skin and peritoneum)

• cannot take oral medications