Diverticulitis
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Synopsis
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. Mild cases can be managed as an outpatient with oral antibiotics, with more severe cases requiring intravenous antibiotics. Complicated diverticulitis may require surgery 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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Diagnostic Pearls
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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, Clostridium 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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Management Pearls
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Therapy
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References
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Last Reviewed:12/07/2016
Last Updated:04/19/2021
Last Updated:04/19/2021
Diverticulitis