Diverticulitis
SUMMARY: Diverticulitis is a trypophobes nightmare with it’s Jarlsburg-esque holy pockets
Key Points
Consider diverticulitis in any patient with LIF pain
CT abdo and pelvis to confirm diagnosis and check for complications
Recurrent imaging not necessary unless failure to improve
Antibiotics not always required if uncomplicated
Surgery is considered if quality of life is significantly impacted
Colonoscopy if complicated diverticulitis to rule out malignancy
Exam
Signs of sepsis, fever, tachycardia
Signs of generalised peritonism
History
Gradual onset LIF pain
Sometimes RIF pain or midline
Nausea, vomiting, fever, possible mucous in stool
Management
Mild cases, uncomplicated
Outpatient
Clear fluids 2-3 days
Analgesia, antipyretic
Consider antibiotics such as amoxicillin-clauvulanate however AVOD trial showed no difference in terms of complications or length of stay with ABx versus no ABx for uncomplicated diverticulitis. Reproduced in 2017 and 2020 trials.
Prevalence
65% of patients over 65 years old, 80% of whom are asymptomatic
Male > female
Possibly increased risk due to low fibre diet
Investigations
FBC, UEC, LFT, Lipase, CRP
Imaging strongly recommended
CT - 94% sensitive, 99% specific
US - 92% sensitive, 90% specific
MRI - 94% sensitive, 92% specific
Fact Sheets
Diet and Diverticulitis QLD Health [PDF]
Diverticular Disease NSW Health [PDF]
Colonoscopy
Colonoscopy at 6-8 weeks post episode has been mainstay treatment.
2019 meta-analysis found risk of colorectal cancer in those with diverticulitis was 2.1% but study was small. However colonoscopy should still be offered.
Fun Fact
Trypophobia brings on feelings of disgust or fear when you see patterns with lots of holes.
Differential Diagnoses
Cancer
IBD
Renal colic
Appendicitis epiploicae (mesenteric torsion)
UTI
Gastroenteritis
Pancreatitis
Meckel’s
Endometriosis / PID
Prevention
High-fibre diet
Weight reduction
Exercise
Smoking cessation
No evidence to avoid nuts, corn, seeds
Reference
AusDoc HTT - Diverticulitis