Patients rarely require resuscitative care unless advanced disease is suspected, such as frank perforation with peritonitis or sepsis. In those instances, emergent intravenous (IV) access, resuscitative fluids, early broad-spectrum antibiotics emphasizing enteric coverage, and prompt surgical consultation should be considered.
Diverticulitis is a disease characterized by inflammation in colonic diverticula. Cases are classified as uncomplicated or complicated on the basis of clinical and radiographic features. Uncomplicated cases are characterized by clinically stable patients with inflammation in a localized area of the bowel wall. By contrast, complicated disease is defined by the presence of abscess, phlegmon, fistula formation, obstruction (large bowel, small bowel), bleeding, perforation, or peritonitis, which are collectively present in about 12% of cases.
Diverticulosis is thought to develop in the setting of increased intraluminal pressure within the bowel and subsequent impairment of bowel wall integrity. Diverticuli may become occluded, leading to bacterial overgrowth with resultant inflammation or infection. Microperforation of diverticuli can lead to more complicated disease. Smoking, obesity, and the use of NSAIDs are associated with increased risk of diverticulosis and diverticulitis.
Patients classically present with abdominal pain (typically left lower quadrant), nausea and/or emesis, and fevers. Changes in bowel habits including loose, sometimes bloody bowel movements, as well as constipation, can occur. The prevalence is strongly associated with age and is most common in adults aged older than 50 years, although the incidence in younger populations has increased steadily in recent decades.
K57.92 – Diverticulitis of intestine, part unspecified, without perforation or abscess without bleeding
307496006 – Diverticulitis
Differential Diagnosis & Pitfalls
- Irritable bowel syndrome
- Colorectal cancer (colon cancer, rectal carcinoma)
- Inflammatory bowel disease
- Acute appendicitis
- Constipation including stercoral colitis
- Ischemic colitis
- Infectious colitis (eg, due to Salmonella, Shigella, Clostridioides difficile; amebic colitis)
- Complicated ulcer disease
- Biliary disease (eg, biliary colic, cholecystitis, cholestasis)
- Ectopic pregnancy
- Urinary tract infection
- Skin / soft tissue abscess
- Adnexal torsion
- Tubo-ovarian abscess
- Hematoma or hemorrhage
- Epiploic appendagitis