Diverticulitis Management and Prevention
Definition and Epidemiology
- Diverticulitis occurs when diverticula become inflamed and/or infected, with an annual incidence in the United States of approximately 180 per 100,000 persons, resulting in more than 1.9 million outpatient visits and 208,000 inpatient admissions annually, and a financial burden of $5.5 billion 1
- The incidence in younger adults (40-49 years) increased by 132% from 1980 through 2007 1
Classification
- Uncomplicated Diverticulitis involves thickening of the colon wall and peri-colonic inflammatory changes, representing approximately 88% of diverticulitis cases 1
Clinical Presentation
- The most common presenting symptom is acute or subacute abdominal pain, usually located in the left lower quadrant, with other common symptoms including fever, changes in bowel habits, nausea, and elevated white blood cell count and/or C-reactive protein (CRP) 1, 4
Diagnosis
- Computed tomography (CT) scan of the abdomen and pelvis with oral and intravenous contrast is the gold standard diagnostic test, with a sensitivity and specificity of approximately 95% 1, 3
- CT findings typically show thickening of the colon wall and increased density of pericolic fat 3
Management
- Most patients with uncomplicated diverticulitis can be managed in an outpatient setting, with antibiotics used selectively rather than routinely in immunocompetent patients with mild uncomplicated diverticulitis 2, 5
Prevention of Recurrence
- To reduce the risk of recurrence, patients should consume a high-quality diet, maintain a normal body mass index, be physically active, avoid smoking, and limit use of nonsteroidal anti-inflammatory drugs (except aspirin prescribed for cardiovascular disease prevention) 2
Important Considerations
- The risk of complicated diverticulitis is highest with the first presentation, and approximately 5% of patients may experience smoldering diverticulitis, characterized by persistent abdominal pain and continued evidence of inflammation on CT scan 1, 2
- Elective segmental resection should not be advised based solely on the number of episodes but should be personalized based on disease severity, patient preferences, and risk-benefit assessment 2