Management of Diverticulitis

Classification and Diagnosis

Diverticulitis is classified as either uncomplicated (localized inflammation) or complicated (associated with abscess, phlegmon, fistula, obstruction, bleeding, or perforation) 1

For patients with acute uncomplicated diverticulitis, selective use of antibiotics rather than routine antibiotic treatment is recommended, with outpatient management preferred for appropriate candidates 1, 2
Antibiotics should be used selectively rather than routinely in uncomplicated diverticulitis (conditional recommendation, low quality evidence) 2, 3
Outpatient management is preferred for select patients with uncomplicated diverticulitis (conditional recommendation, low-certainty evidence) 1

Colonoscopy is recommended after resolution of acute diverticulitis to exclude colonic neoplasm if a high-quality examination has not been recently performed (conditional recommendation, low quality evidence) 4, 5
A fiber-rich diet or fiber supplementation is suggested for patients with a history of acute diverticulitis (conditional recommendation, very low quality evidence) 4, 7

Patients should not be routinely advised to avoid consumption of nuts, popcorn, and seeds (conditional recommendation, very low quality evidence) 7, 8
Patients should not be routinely advised to avoid aspirin (conditional recommendation, low quality evidence) 8, 9
Mesalamine is not recommended after acute uncomplicated diverticulitis (strong recommendation, moderate quality evidence) 5, 9

Elective colonic resection is not recommended after an initial episode of acute uncomplicated diverticulitis (conditional recommendation, very low quality evidence) 5, 6
Approximately 20% of patients with acute uncomplicated diverticulitis experience recurrence within 5 years, but risk of complications requiring emergency surgery is low (<5%) 6