Diverticulitis

Clinical Manifestations

Complicated diverticulitis includes diverticulitis associated with uncontained, free perforation with systemic inflammatory response, fistula, abscess, stricture, or obstruction
Uncomplicated diverticulitis is diverticulitis not meeting the above definition, and includes microperforation with small amounts of contained, extraluminal gas without systemic inflammatory response

For uncomplicated diverticulitis:
- Observation alone with ibuprofen or acetaminophen, preferred
- Some consider ten days of amoxicillin-clavulanic acid, or a combination of fluoroquinolone and metronidazole
  - Indicated for patients with immunocompromise, comorbidities, or frailty, with refractory symptoms or vomiting, with CRP >140 mg/L or WBC >15
  - Indicated if intraabdominal fluid collection present
For complicated diverticulitis:
- Antibiotic treatment as above
Dietary modification: a clear liquid diet during acute phase of uncomplicated diverticulitis, advanced as symptoms improve
Some patients may benefit from colonoscopy following an episode of diverticulitis (either complicated, or first-episode uncomplicated)
- Typically done 6 to 8 weeks after onset and following resolution of symptoms

Eat high-quality diet that is high in fibre from fruits, vegetables, whole grains, and legumes, and low in red meat and added sugar; or a vegetarian diet
- No need to avoid nuts, seeds, or corn
Maintain normal BMI
Be physically active
Smoking cessation
Treat alcohol use disorder
Avoid regular NSAID use
However, 50% of risk is genetic