Diverticulitis

Diverticula: Outpouchings along the mucosal wall of the colon.

Diverticulosis: Refers to the presence of uninflamed diverticula and is the most common cause of lower GI bleeding.

Diverticulitis: Inflamed diverticula which result from obstruction/infection of diverticula.

Pathophysiology

The Sigmoid colon is the most common area for diverticula to occur due to high intraluminal pressure. Additional risk factors include low fiber diet, constipation, and obesity.

Clinical Manifestation

Patients are usually asymptomatic. Once obstructed the diverticula become distended causing left lower quadrant (LLQ) discomfort which is the most common clinical symptom of diverticulitis.

Additional Symptoms: fever, nausea, vomiting, diarrhea, constipation and bloating.

Diagnosis

CT abdomen/pelvis is the test of choice to diagnose diverticulitis.

Barium enema could also provide a diagnosis and should not be performed in the acute phase.

Patients may also have leukocytosis or positive guaiac test.

Treatment

Patients with diverticulitis should be remain NPO and started on antibiotics to treat the infection.

Ciprofloxacin or Bactrim combined with Metronidazole

Patients with known diverticulosis should be advised to follow a high fiber diet or obtain fiber supplements. Roughly 90% of patients with a positive guaiac test 90% experience bleeding resolution. In cases of continued bleeding patients may be given vasopressin to help facilitate hemorrhage resolution.