Treatment of Uncomplicated Diverticulitis

Patient Selection

The American Gastroenterological Association suggests that patients with a prior history of imaging-confirmed diverticulitis and similar presenting symptoms can be treated without initial imaging 2
Patients suitable for treatment without imaging should have no signs of complications, such as severe pain, peritonitis, high fever, or inability to tolerate oral intake, as recommended by the American College of Radiology 1, 3
Immunocompetent patients with adequate family and social support for outpatient management can be treated without imaging, according to the American College of Physicians 2, 4
Patients with no evidence of systemic inflammatory response can be treated without imaging, as suggested by the American College of Physicians 4

Typical presentation of diverticulitis includes left lower quadrant pain, which is the most common symptom, as reported by the American Gastroenterological Association 2, 5
Fever may be present, but is not required for diagnosis, according to the American Gastroenterological Association 2
Change in bowel habits and nausea without vomiting are common symptoms, as reported by the American Gastroenterological Association 5
Elevated white blood cell count and/or C-reactive protein (CRP) can be indicative of diverticulitis, as suggested by the American Gastroenterological Association 5

Imaging should be obtained for patients with a first episode of suspected diverticulitis to confirm diagnosis, as recommended by the American Gastroenterological Association 2, 5
Severe presentation suggesting complications, such as severe pain or high fever, requires imaging, according to the American Gastroenterological Association 2, 5
Failure to improve with therapy necessitates imaging, as suggested by the American Gastroenterological Association 2
Immunocompromised patients require imaging, according to the American Gastroenterological Association 2
Patients with multiple recurrences, especially if contemplating prophylactic surgery, should undergo imaging, as recommended by the American Gastroenterological Association 2
Symptom duration before clinical presentation longer than 5 days requires imaging, according to the American College of Physicians 4
Signs of perforation, bleeding, obstruction, or abscess necessitate imaging, as suggested by the American College of Physicians 4

Clinical diagnosis alone is correct in only 40-65% of patients, with misdiagnosis rates between 34-68%, as reported by the American Gastroenterological Association and the American College of Radiology 1, 2
The classic triad of diverticulitis is present in only approximately 25% of patients, according to the American College of Radiology and the World Journal of Emergency Surgery 1, 6
Colorectal cancer can mimic diverticulitis, with a 1.16% prevalence of cancer among patients with uncomplicated diverticulitis, as reported by the World Journal of Emergency Surgery 7
Patients with predictors of progression to complicated diverticulitis should undergo imaging rather than empiric treatment, as suggested by the American College of Physicians 4

Colonoscopy is advised after a first episode of uncomplicated diverticulitis, but may be deferred if a high-quality colonoscopy was performed within the past year, as recommended by the American Gastroenterological Association 2
Colonoscopy should be delayed by 6-8 weeks or until complete resolution of acute symptoms, whichever is longer, according to the American Gastroenterological Association 2
Earlier colonoscopy should be considered if alarm symptoms are present, such as change in stool caliber, iron deficiency anemia, or blood in stool, as suggested by the American Gastroenterological Association 2