Diverticulitis Further reading : http://emedicine.medscape.com/article/173388-overview

Interesting Links : http://www.diseasesdatabase.com/links1.asp?glngUserChoice=7903

Inflammation of the COLONIC DIVERTICULA, generally with abscess formation and subsequent perforation

See also : Persistent vitelline duct

Diverticulitis

1. 1.

See Also Diverticulosis

2. Pathophysiology 1.

COMPLICATES 5% OF DIVERTICULOSIS

2. 1. MOST OFTEN AFFECTS SIGMOID COLON

DISTRIBUTION

2. Right Diverticular Disease in age <60 and asians

3. 1. Impacted with fecal material

(fecalith)

INFLAMMATION OF COLONIC DIVERTICULA

2. Colon Perforation 1. Microperforation

(Simple Diverticulitis) 1. Peridiverticulitis with

localized phlegmon 2. Infection walled off by

pericolic fat

2. Macroperforation (Complicated Diverticulitis)

1. Pericolic abscess or 2. Free perforation with

generalized peritonitis 3. Fistulas may form

between adjacent structures

3. Symptoms 1. Mild anorexia 2. Nausea or Vomiting 3. Chills 4. Diarrhea or cobstipation 5. Abdominal Pain: Acute constant pain

1. Initial: Hypogastric pain 2. LATER: LEFT LOWER

QUADRANT ABDOMINAL PAIN (>92%)

4. Signs 1. Fever 2. Tenderness over left lower quadrant 3.

GUARDING AND REBOUND TENDERNESS MAY BE PRESENT

5. Labs 1.

1. COMPLETE BLOOD COUNT

Leukocytosis (>68% of cases)

2. 1.

URINALYSIS

DYSURIA AND URINARY FREQUENCY MAY OCCUR

6. Radiology 1.

1.

ABDOMINAL FLAT AND UPRIGHT ABDOMEN

2. Observe for abdominal free air Small Bowel Obstruction

2. 1. Best test to confirm

ABDOMINAL CT WITH CONTRAST Diverticulitis

2. Best test to identify complications (perforation)

3. Findings suggestive of perforation 1. Pericolic fat infiltration 2. Fascial thickening and muscle

hypertrophy 3. Arrowhead sign

1. Localized bowel wall thickening

2. Bowel lumen resembles arrow shape at diverticulum

3. 1. Risk of worsening perforation

AVOID COLONOSCOPY IN ACUTE DISEASE

4. 1. Risk of extravasation if perforation

AVOID BARIUM ENEMA IN ACUTE DISEASE

7. Management: General Measures 1. Clear Liquid Diet (NPO in severe disease) 2. Low fiber diet in acute phase 3. Avoid Narcotics

1. Except

(INCREASES INTRACOLONIC PRESSURE)

Meperidine (decreases intraluminal pressure)

4.

ANTICIPATE IMPROVEMENT WITHIN 48-72 HOURS

8. Management: Outpatient Mangement of mild disease

1.

1. Uncomplicated

INDICATIONS FOR OUTPATIENT MANAGEMENT

Diverticulitis 2. Stable clinically 3. Tolerating oral fluids

2. 1. Primary protocol (requires 2 agents for 7-

10 days)

ANTIBIOTIC REGIMEN

1. CIPROFLOXACIN 500 mg PO bid or Septra DS PO bid and

2. METRONIDAZOLE (Flagyl) 500 mg PO q6 hours

2. Alternative protocol 1. AUGMENTIN 500 mg PO

tid for 7-10 days

9. Management: Inpatient 1.

1. Age >85 years INDICATIONS FOR HOSPITALIZATION

2. Significant inflammation 3. Unable to take oral fluids

2. 1. Nothing by mouth initially

GENERAL MEASURES

3.

1. Primary agents

ANTIBIOTIC REGIMEN FOR MODERATE DISEASE

1. Unasyn 3 g IV q6 hours 2. Zosyn 3.375 g IV q6 hours 3. Timentin 3.1 g IV q6 hours

2. Alternative agents 1. Cefoxitin 2 g IV q8 hours 2. Cefotetan 2 g IV q12 hours 3. Ciprofloxacin 400 mg IV q12h

with Flagyl 500 IV q6h

4.

1. Primary agents

ANTIBIOTIC REGIMEN FOR SEVERE DISEASE (E.G. ICU)

1. Imipenem 500 mg IV q6 hours or

2. Merepenem 1 g IV q8 hours 2. Alternative agents

1. Trovafloxacin 300 mg IV day 1, then 200 mg IV qd or

2. Three agent protocol 1 1. Ampicillin 2 g IV q6

hours and 2. Metronidazole 500 mg

IV q6 hours and 3. Aminoglycoside

(requires monitoring of levels)

1. Gentamicin or

2. Tobramycin or

3. Amikacin 3. Three agent protocol 2

1. Ampicillin 2 g IV q6 hours and

2. Metronidazole 500 mg IV q6 hours

3. Ciprofloxacin 400 mg IV q12 hours

10. Course 1. Improves on antibiotics within 48 to 72

hours

11. Follow-up 1.

1. Define extent of

COLONOSCOPY 6 WEEKS AFTER DIVERTICULITIS EPISODE

Diverticulosis 2. Evaluate for Colon Cancer 3. Barium Enema may be used as alternative

option

2. 1. Recurrent

SURGICAL INDICATIONS Diverticulitis (more than

1 episode)

12. Complications 1. Colonic perforation 2. Colonic abscess 3. Generalized peritonitis 4. Colonic fistula

13. Prevention 1. High fiber diet (except in acute phase - see above) 2. Maintain adequate hydration

14. Prognosis 1. After first episode, recurs in 20-30% of cases 2. After second episode, recurs in 50% of cases

15. References 1. Gilbert (2002) Sanford Guide to

Antimicrobials, p. 14 2. Simmang in Feldman (1998)

Gastrointestinal, p. 1793-7 3. Salzman (2005) Am Fam Physician 72:1229

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Inflammation of a DIVERTICULUM or diverticula.

Literature | 5,617 results

Obesity increases the risks ofdiverticulitis and diverticular bleeding.

Authors: Lisa L Strate, Yan L Liu, WalidH Aldoori, Sapna Syngal, Edward LGiovannucciGastroenterology 2009 Jan

Diverticulitis in the United States:1998-2005: changing patterns ofdisease and treatment.

Authors: David A Etzioni, Thomas MMack, Robert W Beart, Andreas M KaiserAnnals of surgery 2009 Feb

Associated Researchers

Thought leaders and organizations workingon research involving Diverticulitis.

Authors

NDSG Craig L FlochWalter E Longo Martin H FlochEric J Dozois

Clinical Trials Sponsors

Wyeth University Hospitalsof Cleveland

Pfizer The SmartPillCorporation

ShirePharmaceuticalDevelopment

Organizations

Mayo Clinic Collegeof Medicine

Yale UniversitySchool of Medicine

Our Lady ofLourdes Hospital

Norwalk Hospital

University ofWashington Schoolof Medicine

Clinical Trials | 125 trials

Laparoscopic Versus Open SigmoidColectomy for Diverticular Disease

conditions: Diverticulitisinterventions: laparoscopic sigmoidresection

Prevention of Recurrence ofDiverticulitis

conditions: Diverticulitisinterventions: SPD476, MMX™mesalazine, 1.2g extended release tablet ;SPD476, MMX™ mesalazine, 1.2gextended release tablet ; SPD476, MMX™mesalazine, 1.2g extended release tablet ;Placebo

News | 8 stories

Laparoscopic diverticulitis surgery in IndiaMumbai with memorable medical tourismPR-inside.com. - October 13, 2009

Uninsured Face Worse Outcomes AfterDiverticulitis newse-Healthcare.

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