Materiały źródłowe

• #1 Diverticulitis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/diverticulitis/diagnosis-treatment/drc-20371764

  A number of conditions can cause pain and other symptoms related to diverticulitis. Your health care professional will do an exam and order tests to determine the cause of symptoms. […] Laboratory tests may be used to rule out other conditions and make a diagnosis: Blood tests for signs of infection and immune-system activity. Urine test. Stool test. Pregnancy test. Liver enzyme test to rule out liver disease. […] A computerized tomography (CT) scan can show inflamed diverticula, abscesses, fistulas or other complications. […] Your healthcare professional may recommend a colonoscopy six weeks or longer after you no longer have symptoms of diverticulitis. A colonoscopy is an exam used to look for irregular growths or cancer in the colon or rectum. A recommendation for this procedure depends on when you last had a colonoscopy and how serious your diverticulitis was.

• #2 Diagnosing Diverticular Disease | NYU Langone Health

  https://nyulangone.org/conditions/diverticular-disease/diagnosis

  Doctors believe that diverticula develop when increased pressure in the colon exacerbates small weaknesses in the layers of muscle, blood vessels, and connective tissue in the colon wall. […] To diagnose diverticular disease, your NYU Langone gastroenterologist asks about your symptoms and takes a medical history. […] The doctor may also perform a physical exam to check for abdominal tenderness, which is common in diverticulitis. […] Your doctor may perform a blood test to look for signs of infection, such as an increase in the number of disease-fighting immune cells called leukocytes. […] An abdominal CT scan is the most precise tool doctors use to diagnose diverticular disease. […] A colonoscopy is a procedure that allows the gastroenterologist to examine the lining of the colon and rectum wall for any problems, including diverticula.

• #3 Diverticular disease: diagnosis and management – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK558086/

  1. This guideline covers the diagnosis and management of diverticular disease in people aged 18 years and over. It aims to improve diagnosis and care and help people get timely information and advice, including advice about symptoms and when to seek help. […] […] 2. Suspect diverticular disease if a person presents with one or both of the following: intermittent abdominal pain in the left lower quadrant with constipation, diarrhoea or occasional large rectal bleeds (the pain may be triggered by eating and relieved by the passage of stool or flatus) or tenderness in the left lower quadrant on abdominal examination. […] […] 3. Do not routinely refer people with suspected diverticular disease unless: routine endoscopic and/or radiological investigations cannot be organised from primary care or colitis is suspected or the person meets the criteria for a suspected cancer pathway. […]

• #4 Diverticulitis: Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/10352-diverticulitis

  Diverticulitis is a complication that can affect people with diverticulosis, small pockets on the inside of their colon. If one of the pockets becomes injured or infected, it can cause inflammation inside. If you have a sharp pain in your lower left abdominal quadrant, it might be diverticulitis. […] If you and your healthcare provider already know that you have diverticulosis, they might recognize your symptoms as possible diverticulitis. But people often dont know, and the symptoms of diverticulitis can resemble many other conditions. Your healthcare provider may begin with some routine tests to rule out other causes, such as a blood test (comprehensive metabolic panel), stool test or urine test. […] When your provider suspects diverticulitis, theyll look for it on imaging tests. A CT scan works well: its quick and can show the extent of the inflammation as well as any related complications. In some cases, your provider might need to look inside your colon with a lighted scope to investigate further. This is called a colonoscopy. They might be able to treat some complications during the colonoscopy.

• #5 Diverticulitis: Symptoms, Causes, Diagnosis, Treatment, Surgery

  https://www.healthline.com/health/diverticulitis

  How is diverticulitis diagnosed? […] A doctor will first perform a physical exam to check your abdomen for tenderness. Theyll also ask about your symptoms, health history, and any medications you take. […] If they need more information, they may perform a digital rectal exam to check for: […] rectal bleeding […] pain […] masses […] other problems […] They may also order other tests to check for signs of diverticulitis and rule out other conditions that may cause similar symptoms, such as ulcerative colitis or Crohns disease. These tests include: […] imaging tests, such as abdominal ultrasound, MRI, CT, and X-ray […] stool test […] urine test […] blood tests […] pelvic exam […] pregnancy test […] If you have diverticulitis, these exams and tests can help your doctor learn if its uncomplicated or complicated.

• #6 Diverticulosis: What It Is, Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/24883-diverticulosis

  Diverticulosis is a common condition that can develop in your colon, especially as you get older. […] Diverticulosis is the condition of having diverticula. Diverticulitis means that there’s inflammation in at least one of your diverticula. This usually means there’s a bacterial infection inside it. […] A healthcare provider may notice the pouches during a routine colonoscopy or GI X-ray exam. This is the most common way of discovering diverticulosis since it usually doesn’t cause symptoms on its own. […] Exams might include: Physical exam. A provider will check your vital signs, palpate (feel) your abdomen and listen to your bowel sounds. They may insert a gloved finger into your anus (digital rectal exam). […] A provider will look for the diverticula and any related complications on imaging tests, such as a CT scan, a barium enema, a flexible sigmoidoscopy or a colonoscopy.

• #7 Diagnosis and Management of Acute Diverticulitis | AAFP

  https://www.aafp.org/pubs/afp/issues/2013/0501/p612.html

  Uncomplicated diverticulitis is localized diverticular inflammation, whereas complicated diverticulitis is diverticular inflammation associated with an abscess, phlegmon, fistula, obstruction, bleeding, or perforation. […] Initial laboratory studies include a complete blood count, basic metabolic panel, urinalysis, and measurement of C-reactive protein. […] Computed tomography, the most commonly performed imaging test, is useful to establish the diagnosis and the extent and severity of disease, and to exclude complications in selected patients. […] Colonoscopy is recommended four to six weeks after resolution of symptoms for patients with complicated disease or for another indication, such as age-appropriate screening. […] In mild, uncomplicated diverticulitis, antibiotics do not accelerate recovery, or prevent complications or recurrences.

• #8 Diverticulitis – Diagnosis, Evaluation and Treatment

  https://www.radiologyinfo.org/en/info/diverticulitis

  Doctors often diagnose diverticulitis using a computed tomography (CT) scan of your abdomen and pelvis. […] A CT scan is the best test to diagnose diverticulitis. It can also help determine the severity of the condition and guide treatment. […] Blood tests look for signs of infection and/or inflammation. These signs may include high white blood cell counts.

• #9 Latest diagnosis and management of diverticulitis | British Journal of Medical Practitioners

  https://www.bjmp.org/content/latest-diagnosis-and-management-diverticulitis

  Diverticular disease is extremely common especially amongst the elderly. […] In the acute setting Computed Tomography is the gold standard investigation and helps classify the stage. […] Evidence to support outpatient treatment of uncomplicated diverticulitis is appearing however hospital admission and treatment with intravenous antibiotics is often required and is highly effective. […] Following successful acute medical management, colonoscopy is usually performed several weeks after resolution to rule out other colonic pathology. […] In clinical practice, inflammatory markers, commonly the White Blood Cell (WBC) count and C-Reactive Protein (CRP) level, are frequently employed to assist in diagnosing diverticulitis and its complications. […] CT can accurately identify extra-luminal complications such as an abscess, phlegmon, adjacent organ involvement, or fistula, as well as recognising other alternative diagnoses such as appendicitis, pelvic inflammatory disease, tubo-ovarian abscess or inflammatory bowel disease.

• #10 Diverticulitis: Symptoms, Causes, Diagnosis, Treatment, Surgery

  https://www.webmd.com/digestive-disorders/understanding-diverticulitis-basics

  How Is Diverticulitis Diagnosed? […] The symptoms of diverticulitis can also look like other problems. Your doctor will narrow things down by ruling out other issues. Theyll start with a physical exam. Women may get a pelvic exam, too. Your doctor may then order one or more tests, including: […] Blood, urine, and stool tests to look for infection […] CT scans to look for inflamed or infected diverticula […] A liver enzyme test to rule out liver problems […] A pregnancy test for women of childbearing age to rule out pregnancy as a cause of abdominal pain […] A poop test to rule out infection when you have diarrhea.

• #11 Diverticular disease: diagnosis and management – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK558086/

  4. Do not offer antibiotics to people with diverticular disease. […] […] 5. Advise people to avoid non-steroidal anti-inflammatory drugs and opioid analgesia if possible, because they may increase the risk of diverticular perforation. […] […] 6. For people with suspected uncomplicated acute diverticulitis who are not referred for same-day hospital assessment: reassess in primary care if their symptoms persist or worsen and consider referral to secondary care for further assessment. […] […] 7. For people with suspected complicated acute diverticulitis who have been referred for same-day hospital assessment, offer a full blood count, urea and electrolytes test and C-reactive protein test. […] […] 8. If the person with suspected complicated acute diverticulitis has raised inflammatory markers, offer a contrast CT scan within 24 hours of hospital admission to confirm diagnosis and help plan management. […]

• #12 Recommendations | Diverticular disease: diagnosis and management | Guidance | NICE

  https://www.nice.org.uk/guidance/ng147/chapter/recommendations

  For people with suspected complicated acute diverticulitis who have been referred for same-day hospital assessment, offer a full blood count, urea and electrolytes test and C-reactive protein test. […] If the person with suspected complicated acute diverticulitis has raised inflammatory markers, offer a contrast CT scan within 24 hours of hospital admission to confirm diagnosis and help plan management. […] For people with acute diverticulitis who are systemically well: […] Offer an antibiotic prescribing strategy if the person with acute diverticulitis is systemically unwell, is immunosuppressed or has significant comorbidity. […] Review intravenous antibiotics within 48 hours or after scanning if sooner and consider stepping down to oral antibiotics where possible. […] When prescribing an antibiotic for suspected or confirmed complicated acute diverticulitis, follow the advice in table 2.

• #13 Diverticulitis of the Colon Imaging and Diagnosis: Practice Essentials, Radiography, Computed Tomography

  https://emedicine.medscape.com/article/367320-overview

  Computed tomography (CT) of the abdomen and pelvis with IV contrast is considered to be the best imaging method because it can confirm the presence of acute colonic diverticulitis, evaluate disease severity and degree, and often differentiate colonic diverticulitis from other diseases. […] The preferred examination for diverticulitis is CT scanning of the abdomen and pelvis. CT findings can help in confirming clinical suspicion of diverticulitis and in excluding other abdominal or pelvic disease. CT can help in evaluating and staging inflammatory disease. The modality can also be used to accurately plan a percutaneous intervention. […] Because clinical findings correlate poorly with the severity of the disease, imaging is necessary to confirm the diagnosis of acute diverticulitis. All major guidelines recommend computed tomography (CT) for the initial assessment of suspected diverticulitis.

• #14 Acute Colonic Diverticulitis: CT Findings, Classifications, and a Proposal of a Structured Reporting Template

  https://www.mdpi.com/2075-4418/13/24/3628

  Acute colonic diverticulitis (ACD) is the most common complication of diverticular disease and represents an abdominal emergency. […] Contrast-enhanced computed tomography (CE-CT) plays a pivotal role in the diagnosis due to its high sensitivity, specificity, accuracy, and interobserver agreement. […] CE-CT represents the diagnostic tool of first choice in patients with suspected diverticulitis, showing high diagnostic sensitivity (98–99%), specificity (99–100%), accuracy (98–99%), and excellent interobserver agreement. […] CE-CT allows, in the scenario of suspected diverticulitis, to 1. confirm the diagnosis and identify the inflamed diverticulum; 2. stage the disease, stratifying patients for operative versus nonoperative treatment; 3. identify complications, depicting the extracolonic disease extent; 4. provide a valid tool in preoperative surgical and radiological interventional planning; and 5. suggest alternative diagnoses presenting similar clinical symptoms and signs (such as neoplasm, inflammatory bowel disease, appendicitis, epiploic appendagitis, and colon ischemia).

• #15 Diverticular Disease – Clinical Features – Management – TeachMeSurgery

  https://teachmesurgery.com/general/large-bowel/diverticular-disease/

  Any patient presenting acutely with suspected diverticular disease should have initial routine blood tests performed, including FBC, CRP, and UEs. Those with suspected diverticulitis, should also have a Group and Save (in case surgical intervention is required) and a venous blood gas (VBG). A urine dipstick may prove helpful to exclude any urological causes. […] For cases of suspected diverticulitis, a CT abdomen-pelvis scan is the investigation of choice. CT findings that can suggest diverticulitis include thickening of the colonic wall, pericolonic fat stranding, abscesses, localised air bubbles, or free air. […] Most patients with acute diverticulitis can be managed conservatively, with antibiotics, intravenous fluids, and analgesia. Indeed, young patients with uncomplicated diverticulitis can be considered for ambulatory management, especially if the patient is systemically otherwise well and no significant co-morbidities or immunosuppression. […] Surgical intervention is usually required in those with perforation with diffuse purulent or faecal peritonitis or overwhelming sepsis. This is a major procedure and usually involves a Hartmanns procedure (a sigmoid colectomy with formation of an end colostomy).

• #16 Sigmoid diverticulitis: US findings | The Ultrasound Journal | Full Text

  https://theultrasoundjournal.springeropen.com/articles/10.1186/2036-7902-5-S1-S5

  Currently, Multidetector Computed tomography (MDCT) of the abdomen is often the diagnostic test of choice, especially in the urgent assessment of patients with AD, with sensitivity, specificity, and positive and negative predictive values all well greater than 95%, allowing the identification of both colonic abnormalities (particularly mural thickening and diverticula) and inflammatory changes in the pericolonic fat planes, grading its severity, and identifying most usual complications. […] The diagnostic criteria for diverticulitis that has been used in US and CT are the same: 1) at least one diverticulum, 2) signs of inflammation of periodic fat (dirty fat/stranding) and 3) thickened bowel wall 4-5 mm. […] Although colonic diverticulitis is easily diagnosed and classified (graded) by CT than by ultrasound (US), it is important to be aware of the US signs of diverticulitis considering that US is often used as a first modality in the diagnostic approach to the acute abdomen.

• #17 Diverticulitis of the Colon Imaging and Diagnosis: Practice Essentials, Radiography, Computed Tomography

  https://emedicine.medscape.com/article/367320-overview

  The American College of Radiology (ACR) Appropriateness Criteria for initial imaging of suspected diverticulitis recommends CT with IV contrast because it provides a more comprehensive initial assessment of the clinical progression and aids in treatment selection. […] In diverticulitis, ultrasonographic findings include thickening of the bowel wall by more than 4 mm. Inflamed diverticula appear as round or ovoid, highly echogenic structures with a ring-down artifact. Inflammation of the pericolic fat is revealed as an area of increased echogenicity adjacent to the colonic wall. […] According to Pradel et al, the sensitivity of ultrasonography is 85% and its specificity is 84% in the diagnosis of diverticulitis. […] The diagnosis of diverticulitis with CT scanning is based on the detection of colonic and paracolic inflammation in the presence of underlying diverticula.

• #18 Imaging for Diverticulitis | Ultrasound Solutions Corp.

  https://www.uscultrasound.com/blog/imaging-for-diverticulitis/

  Recent studies have suggested that there is no significant difference in the test performance characteristics of CT as opposed to ultrasound for the diagnosis of diverticulitis. […] If utilized by providers with appropriate training, point-of-care ultrasound represents an ideal first-line imaging test for uncomplicated diverticulitis, with CT imaging reserved for ill-appearing patients with unstable vital signs, or for those whose point-of care ultrasound images demonstrate findings concerning complicated diverticulitis, such as an abscess or intra-abdominal free fluid.

• #19 Colonic Diverticulitis – Gastrointestinal Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/gastrointestinal-disorders/diverticular-disease/colonic-diverticulitis

  Diverticulitis is inflammation with or without infection of a diverticulum, which can result in phlegmon of the bowel wall, peritonitis, perforation, fistula, or abscess. Diagnosis is by CT and ultrasound. […] Clinical suspicion is high in patients with known diverticulosis who present with characteristic abdominal symptoms. However, because other disorders (eg, appendicitis, colon or ovarian cancer, inflammatory bowel disease) may cause similar symptoms, testing is required. […] Diverticulitis is evaluated with CT of the abdomen and pelvis with water-soluble contrast given orally and rectally; IV contrast also is given when not contraindicated. However, findings in approximately 10% of patients cannot distinguish diverticulitis from colon cancer. MRI is an alternative for pregnant and young patients.

• #20 Diverticulitis Diagnosis: Testing and Similar Conditions

  https://www.verywellhealth.com/diverticulitis-diagnosis-7096218

  Diverticular disease might be found during a routine colonoscopy. […] An MRI is helpful in diagnosing diverticulitis. […] An ultrasound is a test that is considered inexpensive and, in some cases might be as helpful in a diagnosis as a CT scan. […] The diagnostic process will include a physical exam, review of symptoms, and medical history. A digital rectal exam, blood tests, urinalysis, and imaging tests may be performed. Many conditions with similar symptoms will need to be considered before making a diagnosis.

• #21 Diagnosis and Management of Acute Diverticulitis | AAFP

  https://www.aafp.org/pubs/afp/issues/2013/0501/p612.html

  Antibiotics may not be necessary in patients with uncomplicated diverticulitis who are being treated in the outpatient setting. […] Computed tomography-guided percutaneous drainage of abscesses should be considered in patients with diverticulitis. […] In patients with diverticulitis, laparoscopic surgery results in a shorter length of stay, fewer complications, and lower in-hospital mortality compared with open colectomy. […] Colonoscopy is contraindicated in acute diverticulitis, but historically was recommended to be performed four to six weeks after resolution of acute diverticulitis to confirm the diagnosis and to exclude other causes (e.g., colorectal cancer).

• #22 Diverticulitis – Wikipedia

  https://en.wikipedia.org/wiki/Diverticulitis

  Diverticulitis, also called colonic diverticulitis, is a gastrointestinal disease characterized by inflammation of abnormal pouches—diverticula—that can develop in the wall of the large intestine. Diagnosis is typically by CT scan, though blood tests, colonoscopy, or a lower gastrointestinal series may also be supportive. […] The diagnosis of acute diverticulitis is made confidently when the involved segment contains diverticula. CT images reveal localized colon wall thickening, with inflammation extending into the fat surrounding the colon. […] Barium enema and colonoscopy are contraindicated in the acute phase of diverticulitis because of the risk of perforation.

• #23 Diagnosis and Management of Acute Diverticulitis | AAFP

  https://www.aafp.org/pubs/afp/issues/2013/0501/p612.html

  Hospitalization should be considered if patients have signs of peritonitis or there is suspicion of complicated diverticulitis. […] Inpatient management includes intravenous fluid resuscitation and intravenous antibiotics. […] Patients with a localized abscess may be candidates for computed tomography-guided percutaneous drainage. […] The decision to proceed to surgery in patients with recurrent diverticulitis should be individualized and based on patient preference, comorbidities, and lifestyle. […] Abdominal computed tomography is the test of choice in patients with suspected diverticulitis. […] Colonoscopy is unnecessary in patients with uncomplicated diverticulitis. […] Inpatient management is recommended in patients with moderate to severe diverticulitis. […] Broad-spectrum antibiotics covering gram-negative rods and anaerobic bacteria should be used in patients with complicated diverticulitis.

• #24 Diverticular disease practice points

  https://www.racgp.org.au/afp/2017/november/diverticular-disease-practice-points

  We recommend that colonoscopy is not necessarily required in patients who are being followed up after uncomplicated diverticulitis. […] The most recent point of contention concerns the utility of antibiotics in treating diverticulitis. […] Early trials suggested that acute uncomplicated diverticulitis can be safely treated without antibiotics and that this management does not increase further events of diverticulitis. […] While the available data suggest that observational management may be safe and effective, they are insufficient to change current practice, as the specific population groups to which this approach should be applied have not been identified.

• #25 Diverticular Disease & Diverticulitis | Causes & Symptoms | Guts UK

  https://gutscharity.org.uk/advice-and-information/conditions/diverticular-disease/

  Diagnosis is made by examination of the inside of the large bowel. During the examination the doctor or nurse endoscopist will be looking for other abnormalities that could be causing your symptoms. Diagnosis is only confirmed once other conditions have been ruled out. This can be done via: […] Colonoscopy or sigmoidoscopy […] A tube with a camera is passed into the large bowel via the back passage to view the inner surface of the large bowel. A sigmoidoscopy is a similar procedure that views less of the large bowel. […] CT scan […] This is a non-invasive x-ray-based test although, as with the colonoscopy, you will be required to completely empty your bowels before the scan.

• #26 Surgical Management of Complicated Diverticulitis | IntechOpen

  https://www.intechopen.com/chapters/1157861

  Diverticular disease is a prevalent condition that affects more people as they get older. […] When the suspicion of an episode of acute diverticulitis arises, the definitive diagnosis should be made by combining clinical findings, history of previous episodes and prior colonoscopies (which would also help to rule out other causes of colonic diseases, like malignancies), and serological markers to assess the inflammatory response (white blood count, C-Reactive protein, etc.). […] As regards imaging methods, CT scan is the current gold standard, because not only it allows the physician to make a diagnosis but also to correctly stage the disease, looking for associated abscess, pneumoperitoneum, and free fluid in the abdominal cavity. […] The most frequently used classification of acute diverticulitis based on imaging is the Hinchey classification, which stratifies the disease into four grades according to CT-scan information and operative findings.

• #27 The Mexican consensus on the diagnosis and treatment of diverticular disease of the colon | Revista de Gastroenterología de México

  https://www.revistagastroenterologiamexico.org/en-the-mexican-consensus-on-diagnosis-articulo-S2255534X19300283

  The presence of diverticula in the colon can be detected through different imaging methods, such as double-contrast barium enema, abdominal ultrasound, virtual colonography, or multi-slice computed tomography. However, strictly speaking, the diagnosis of diverticular disease (DD) requires a sectioned imaging study that has few associated undesirable effects and is cost-effective for diagnostic purposes. Computed tomography has the advantage of being an operator-independent, reproducible, and widely available method that offers a high degree of diagnostic accuracy, provides extraintestinal images, and makes it possible to classify each case, with the consequent treatment and outcome implications. Therefore, it is considered the standard study in the diagnosis of complicated DD. […] The Hinchey classification and its modifications have been shown to aid in determining the best therapeutic focus and predicting complications in patients that require surgery. […] Colonoscopy is useful for the diagnosis and treatment of diverticular bleeding and for the diagnosis of segmental colitis associated with diverticulosis. The routine use of colonoscopy is not recommended in the evaluation of acute diverticulitis.

• #28 11.8 Diverticulitis – Health Alterations

  https://wtcs.pressbooks.pub/healthalts/chapter/11-8-diverticulitis/

  A diverticulum is an out-pouching of the wall of the colon. The presence of many diverticula is known as diverticulosis. Clients with diverticulosis are generally asymptomatic, but a small percentage develop diverticulitis, inflammation of a diverticulum. […] Diverticulitis can be complicated or uncomplicated. Uncomplicated diverticulitis means there is inflammation with no complications present. Complicated diverticulitis refers to diverticulitis associated with an abscess, perforation, fistula (an abnormal connection between two organs), or a bowel blockage. […] Risk factors for diverticulosis and diverticulitis are the same, with the main risk factors being dietary intake. Clients with low-fiber intake or high intake of red meat and fatty foods are at increased risk for developing diverticulosis and diverticulitis.

• #29 Diverticular disease | NHS inform

  https://www.nhsinform.scot/illnesses-and-conditions/stomach-liver-and-gastrointestinal-tract/diverticular-disease-and-diverticulitis/

  Diverticular disease can be difficult to diagnose from the symptoms, alone because there are other conditions that cause similar symptoms, such as irritable bowel syndrome (IBS). […] As a first step, your GP may recommend blood tests to rule out other conditions such as coeliac disease (a condition caused by an abnormal immune response to gluten) or bowel cancer. […] To make sure there is not a more serious cause of your symptoms, your GP may refer you for a colonoscopy, where a thin tube with a camera at the end (a colonoscope) is inserted into your rectum and guided into your colon. […] Another technique for confirming the presence of diverticula is a computerised tomography (CT scan). […] If you have had a previous history of diverticular disease, your GP will usually be able to diagnose diverticulitis from your symptoms and a physical examination.

• #30 Latest diagnosis and management of diverticulitis | British Journal of Medical Practitioners

  https://www.bjmp.org/content/latest-diagnosis-and-management-diverticulitis

  However despite CT having a reported sensitivity of 97%, specificity of 98%, and global accuracy of 98%, a misdiagnosis of diverticulitis in cancer patients is relatively common and occurs in 5% of cases. […] Evidence for successful and economical outpatient treatment of uncomplicated diverticulitis is beginning to emerge. […] Most patients with uncomplicated disease respond well to medical treatment and generally experience significant improvement in their abdominal pain, temperature and inflammatory markers within two days of initiation of antibiotic treatment. […] The decision to proceed with elective surgery is judged on an individual basis and there is evidence gathering to advocate a laparoscopic approach. […] The indications for emergency operative intervention in acute diverticulitis include the presence of generalised peritonitis, uncontained visceral perforation, gross uncontrollable sepsis, a large undrainable or inaccessible abscess, bowel obstruction and lack of improvement or clinical deterioration with initial medical management.

• #31 Diverticular Disease: Diagnosis and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2005/1001/p1229.html

  Laboratory studies and imaging can be used judiciously to confirm a diagnosis of diverticulitis and to exclude other potential causes of similar symptoms. […] Although computed tomography (CT) has been used commonly in the investigation of diverticular disease, the morphology of diverticular segments makes the diagnosis of underlying cancer difficult even with ideal technique. […] Uncommonly, ultrasonography is used to confirm the diagnosis, primarily in patients with right-sided pain in whom other diseases (e.g., ovarian pathology) are suspected. […] Colonoscopy always should be performed six to eight weeks after recovery from acute diverticulitis to exclude coexisting neoplastic disease.

• #32

  https://bpac.org.nz/2023/diverticulitis.aspx

  Diverticulitis occurs when small pockets in the wall of the large bowel become inflamed, usually without a specific identifiable cause. […] The diagnosis of diverticulitis can be challenging in primary care. […] International guidelines recommend a CT scan with contrast to diagnose acute diverticulitis, however, limited access and availability of appropriate imaging in New Zealand means a more pragmatic approach is required. […] For patients with less severe symptoms, a clinical diagnosis of uncomplicated diverticulitis can be made after reasonable exclusion of other causes, and conservative treatment initiated in the community. […] Antibiotics are no longer routinely recommended for most patients with suspected acute uncomplicated diverticulitis; oral antibiotics may be considered for some patients who are at higher risk of complications.

• #33

  https://bpac.org.nz/2023/diverticulitis.aspx

  A clinical diagnosis of diverticulitis can be made from patient history, a physical examination and laboratory testing. […] There are no specific laboratory investigations for diverticular disease, however, some tests may be useful for assessing disease severity in an unwell patient. […] Patients with uncomplicated acute diverticulitis can usually be managed in the community. […] The appropriate level of intervention for patients with acute diverticulitis is determined by their clinical condition and co-morbidities. […] Some patients may experience recurrent or chronic episodes of diverticulitis. […] Some patients will require follow-up colonoscopy to exclude colorectal cancer.

• #34 Latest diagnosis and management of diverticulitis | British Journal of Medical Practitioners

  https://www.bjmp.org/content/latest-diagnosis-and-management-diverticulitis

  The appropriate management of diverticular abscesses is a matter of some debate. However according to the American Society of Colon and Rectal Surgeons (ASCRS) radiologically guided percutaneous drainage is usually the most appropriate treatment for patients with a large diverticular abscess as it avoids the need for emergency surgery and possibility of a colostomy. […] Following successful medical management of an acute episode of diverticulitis, colonoscopy, flexible sigmoidoscopy or barium enema should be performed several weeks after the resolution of symptoms to confirm the diagnosis and rule out other colonic pathology such as malignancy, inflammatory bowel disease, or ischemia.

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