Acute Diverticulitis


Uncomplicated vs complicated (abscess, perforation, obstruction, fistula, or peritonitis)

[Age]-yo [M/F] with PMH of ___, presenting with
[X] days of [constant/intermittent], [progressively worsening/improving]
CC: abdominal pain (typically LLQ) ± fever, anorexia, diarrhea or constipation
PP: LLQ tenderness, possible guarding
PN: denies N/V/D, hematochezia, urinary symptoms
Hx:
Initial DATA: CBC , CMP , CT A/P with contrast → uncomplicated vs complicated diverticulitis
Pending DATA: blood cultures if febrile/septic
Etiology/DDx: *** LLQ pain - UTI, nephrolithiasis, pregnancy, gastroenteritis, ischemia, hernia, malignancy, IBD, appendicitis, ileus/obstruction

Plan

  • IV fluids, pain control (APAP), antiemetic

  • Uncomplicated: ± antibiotics (ceftriaxone + metronidazole) to PO* once improved → augmentin total 7 days

  • Complicated: cefepime + metronidazole -> once improved → augmentin or cipro + flagyl 10-14 day

  • Uncomplicated: supportive care, bowel rest → clear liquid diet vs NPO advance diet as tolerated

  • Complicated -> Abscess → IR drainage if ≥3–5 cm, Perforation/peritonitis/obstruction → urgent surgery consult

  • Avoid colonoscopy acutely → colonoscopy in 6–8 weeks

  • trend labs daily

  • PT OT for eval

NOTE:

  • Peritonitis sign: Severe, diffuse abdominal pain (worse with movement), Guarding + rigidity (“board-like abdomen”) , Rebound tenderness fever, Nausea/vomiting, ↓ appetite, Tachycardia ± hypotension (if severe/septic)

  • Chart Check: prior surgeries, abdominal infection, co-morbidities, immunosuppression,