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