Diverticulitis

Question 1

What is diverticulitis?

Answer 1

Inflammation of diverticula resulting in clinical symptoms

Question 2

What is the pathophysiology of diverticulitis?

Answer 2

Stool gets lodged in diverticula → obstruction of intestinal lumen → increased intraluminal pressure and erosion of diverticula wall → inflammation

Question 3

What are clinical features of diverticulitis?

Answer 3

Low-grade fever
Sigmoid colon most commonly affected → left lower quadrant pain 
Possibly tender, palpable mass 
Change in bowel habits
Nausea / Vomiting 
↑ Urinary urgency and frequency

Question 4

How is diverticulitis diagnosed?

Answer 4

IV contrast enhanced CT scan (best)
MRI or US
Colonoscopy to rule out malignancy after resolution (contraindicated in actue phase due to perforation risk)
(Labs) CBC: leukocytosis; possible anemia
↑ CRP
Fecal occult blood test

Question 5

What is the classification of diverticulitis?

Answer 5

(Uncomplicated diverticulitis) localized inflammation of a colonic diverticulum with no evidence of complications
(Complicated diverticulitis) Inflammation of a colonic diverticulum associated with complications such as perforation, abscess, fecal peritonitis, bowel obstruction, or fistula formation

Question 6

What is the treatment for diverticulitis?

Answer 6

(Uncomplicated) Oral antibiotics (i.e. ciprofloxacin + metronidazole)
(Complicated) broad-spectrum IV antibiotics
CT-guided drainage for cysts
Emergency colectomy for generalised peritonitis