# *** Uncomplicated/Complicated Diverticulitis
Complicated if : bowel obstruction, abscess, fistula, perforation; imaging of inflammation, fat-strianding, etc is un-complicated
Consider Abx in uncomplicated if: fevers, WBC >15, CRSP >140, immunosuppressed, significany co-morbidities, symptoms >3-5 days
-- ABCs: profound hypotension or evidence of peritonitis gets STAT surgery consult
-- Chart Check: prior surgeries, abdominal infection, co-morbidities, immunosuppression,
-- Admission Orders: clear liquid diet vs NPO
-- Initial Treatment: fluids, tylenol and dicylcomine, antibiotics if needed
-- History: *** known diverticulosis, last colo, immunocompromised
-- Clinical: *** LLQ pain, fever, anorexia, diarrhea or constipation
-- Exam: *** fever, LLQ abd pain, evidence of peritonitis
-- Data: *** WBC, CTAP
-- Etiology/DDx: *** LLQ pain - UTI, nephrolithiasis, pregnancy, gastroenteritis, ischemia, hernia, malignancy, IBD, appendicitis, ileus/obstruction
The patient's HPI is notable for ***. Exam showed ***. Labwork and data were notable for ***. Taken together, the patient's presentation is most concerning for ***, with a differential including ***.
-- CTAP with IV contrast if concern for complicated diverticulitis or not improving in 2-3 days
-- Abx: *** Uncomplicated - can consider 7 days PO cipro/flagyl, bactrim/flagyl or augmentin; Complicated - IV Zosyn with transition to PO for 10-14 day course
-- Palliative: *** tylenol, dicylcomine, zofran PRN
-- IVF: ***
-- Bowel Rest → high fiber diet
-- If complicated - surgical consult, IR consult to drain an abscess, etc
-- Colonoscopy 6 weeks after the acute event (if not done in the last year) to assess for malignancy
PDF coming soon!
Diverticulitis is an infection of a colon diverticula, most commonly located on the left-side of the sigmoid colon. Historically, all-comers with diverticulitis have historically been treated with antibiotics; however recent data and guidelines suggest that foregoing antibiotics in uncomplicated diverticulitis is non-inferior to treating and does not prolong length of stay. If you do end up treating, it should be 7 days of PO antibiotics and based on clinical judgement. If the patient has complicated diverticulitis (bowel obstruction, asbcess, fistula, perforation), it should be treated with IV broad spectrum antibiotics that cover GNRs and anaerobes and should involve surgical teams.