Management of Mild Diverticulitis Without Leukocytosis or Fever

Definition and Clinical Assessment

Uncomplicated diverticulitis is defined as localized diverticular inflammation without any abscess or perforation, typically presenting with left lower quadrant pain and tenderness 3
The absence of leukocytosis and fever suggests a mild, uncomplicated case with low risk of complications 1, 2
CT findings in uncomplicated diverticulitis include diverticula, wall thickening, and increased density of pericolic fat without evidence of abscess, perforation, or fistula formation 2

Conservative treatment without antibiotics is recommended for uncomplicated diverticulitis 2, 3
Multiple high-quality randomized controlled trials have demonstrated that antibiotic therapy neither accelerates recovery nor prevents complications or recurrence in uncomplicated diverticulitis 2, 4
The AVOD study showed no difference in outcomes between patients treated with or without antibiotics for uncomplicated diverticulitis 2
The DIABOLO trial confirmed that observational treatment without antibiotics did not prolong recovery in patients with CT-proven uncomplicated diverticulitis 2, 5

Close monitoring for clinical deterioration is necessary 2
If the patient deteriorates, consider repeating CT scan and initiating antibiotics if temperature rises or signs of sepsis develop 5
Patients with ongoing signs of infection beyond 7 days warrant further diagnostic investigation 1

Immunocompromised patients, including those receiving chemotherapy, high-dose steroids, or post-transplant, may require antibiotics 2
Patients with CT evidence of complicated diverticulitis, such as abscess, perforation, or fistula, require antibiotics 2, 3

Overuse of antibiotics in mild uncomplicated cases can contribute to antibiotic resistance without providing clinical benefit 2, 3
Failure to recognize high-risk patients who would benefit from antibiotics despite mild presentation, such as immunocompromised or elderly patients, can lead to poor outcomes 2, 4
Inadequate follow-up to ensure resolution of symptoms can lead to delayed diagnosis of complications 1
Missing signs of progression to complicated diverticulitis can lead to delayed treatment 2