Acute diverticulitis

Headline
Etiology Dysregulation of microbiome?
Epidemiology Risk factors for Diverticular disease: low dietary fibre, smoking, alcohol excess
Clinical presentation rectal bleeding/blood in stool, LLQ abdo pain, fever
Pathogenesis
Diagnostic investigations CT if suspicion of collection/perforation
Management Uncomplicated and well: analgesia, antispasmodic, consider PO abx if risk factors present:
>> systemic inflammation, is immunosuppressed, or has significant comorbidities
>> CKS recommends co-amox, or cefalexin with metronidazole if allergic

Complicated: IV abx, IV fluids etc.
Avoid NSAIDs

consider hospital treatment if:

  • Is dehydrated or at risk of dehydration and is unable to take or tolerate oral fluids at home. 
  • Is unable to take or tolerate oral antibiotics (if needed) at home. 
  • Is aged over 65 years.
  • Has significant comorbidity or immunosuppression.