Diverticulitis
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Synopsis
Diverticulitis is a disease characterized by inflammation in colonic diverticula. Patients classically present with abdominal pain (typically left lower quadrant), nausea and/or emesis, and fevers. Loose and sometimes bloody bowel movements can be seen as well. Diverticulitis occurs in patients who have diverticulosis, which increases in prevalence with age and is observed in the majority of patients aged older than 50 years.The underlying etiology is thought to be due to microperforation of diverticula. Smoking, obesity, and the use of NSAIDs are associated with increased risk of diverticulosis and diverticulitis. CT of the abdomen and pelvis confirms the diagnosis in most instances.
Treatment is determined by severity and complexity of diverticulitis. Most patients with mild uncomplicated cases can be managed as an outpatient without oral antibiotics, although selective use of antibiotics is advised for some patients. Complicated diverticulitis requires antibiotic treatment, with severe cases requiring intravenous antibiotics; surgery may be required in some instances.
The Hinchey staging system classifies abscesses and free perforation:
- Stage I – small pericolic or mesenteric abscesses
- Stage II – abscess is larger and confined to pelvis
- Stage III – purulent peritonitis
- Stage IV – fecal peritonitis
Codes
ICD10CM:K57.92 – Diverticulitis of intestine, part unspecified, without perforation or abscess without bleeding
SNOMEDCT:
307496006 – Diverticulitis
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Differential Diagnosis & Pitfalls
- Irritable bowel syndrome
- Colorectal cancer (colon cancer, rectal carcinoma)
- Inflammatory bowel disease (eg, Crohn disease, ulcerative colitis)
- Acute appendicitis
- Constipation (eg, drug induced) and/or fecal impaction
- Ischemic or infectious colitis (eg, due to Salmonella, Shigella, Clostridioides difficile; amebic colitis)
- Complicated ulcer disease
- Gallbladder disease (eg, biliary colic, cholecystitis, cholestasis)
- Ectopic pregnancy
- Urinary tract infection
- Nephrolithiasis
- Endometriosis
- Skin / soft tissue abscess
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References
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Last Reviewed:12/07/2016
Last Updated:11/01/2022
Last Updated:11/01/2022
Diverticulitis