Management of Acute Diverticulitis

Abstract

Diverticular disease of the colon is a common condition, and the prevalence increases with age, affecting up to 60% of persons older than 60 years. 1 Approximately 4% of patients with diverticulosis will develop acute diverticulitis, defined as clinically evident macroscopic inflammation of a diverticulum or diverticula. 2 Eighty-five percent of episodes of acute diverticulitis are uncomplicated (defined by absence of abscess, bowel obstruction, perforation, or fistula formation), although 15% to 30% of patients who develop acute diverticulitis experience a recurrence. 3 Diverticulitis remains the leading indication for elective colon resection. 4

American Association for the Surgery of Trauma emergency general surgery guideline summaries 2018: acute appendicitis, acute cholecystitis, acute diverticulitis, acute pancreatitis, and small bowel obstructionAcute cholecystitis management guidelines summaryAcute colonic diverticulitis management guidelines summaryIntestinal obstruction due to adhesions guideline summaryAcute pancreatitis management guidelines summary

“…For the management of uncomplicated diverticulitis (grades 1 and 2), it is safe and reasonable to manage as an outpatient in otherwise healthy patients. 2, 3, 4, 9, 10, 11…”

“…Antibiotics have not been shown to decrease the severity or duration of symptoms and may be associated with allergic reaction and resistance. 3, 4, 9, 11…”

“…2 As the population ages, these numbers are likely to increase, since at least 60% of people over the age of 60 have diverticulosis and 10%–25% will progress to diverticulitis at some point. 2-3 Though 85% of these episodes are likely to be uncomplicated, 15%–30% will experience at least one recurrence. 3…”

“…2-3 Though 85% of these episodes are likely to be uncomplicated, 15%–30% will experience at least one recurrence. 3…”

Current Controversies in the Management of Diverticulitis: A Review

“…Details of these trials are given in Table 2. This evidence is incorporated in the "2017 American Gastroenterological Association (AGA) Institute Guideline on the Management of Acute Diverticulitis" which promotes selective individualised as opposed to routine use of antibiotics in this presentation [22].…”