Materiały źródłowe

• #1 Diverticulitis – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/diverticulitis/symptoms-causes/syc-20371758

  Diverticulitis is inflammation of irregular bulging pouches in the wall of the large intestine. […] When these pouches become inflamed, the condition is called diverticulitis. Inflammation of diverticula can cause severe pain, fever, nausea and changes in your stool habits. […] Mild diverticulitis is usually treated with rest, changes in your diet and possibly antibiotics. Severe diverticulitis usually needs antibiotic treatment in the hospital. Surgery may be needed for severe or frequent diverticulitis. […] Diverticulitis is inflammation of one or more diverticula. This may happen because of bacterial disease or damage to diverticula tissues.

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

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

  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. […] 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. […] 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.

• #2 Diverticulosis and Diverticulitis: Diagnosis & Treatment | NewYork-Presbyterian

  https://www.nyp.org/digestive/colorectal-diseases/diverticular-disease/treatment

  How Are Diverticulosis and Diverticulitis Diagnosed? […] If you have symptoms of diverticulitis, your doctor will likely begin by asking you about your medical history and what kind of symptoms you are experiencing. […] Following this, some or all of the following tests may be used to confirm a diverticulosis or diverticulitis diagnosis: […] Blood and urine tests to check for signs of infection […] A stool sample, which can reveal bacteria, blood, and other abnormalities in the stool […] A liver enzyme test to rule out liver-related causes of abdominal pain […] A CT scan, which can reveal inflamed diverticula and the severity of the condition.

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

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

  Do not offer antibiotics to people with diverticular disease. […] Advise people to avoid non-steroidal anti-inflammatory drugs and opioid analgesia if possible, because they may increase the risk of diverticular perforation. […] Suspect acute diverticulitis if a person presents with constant abdominal pain, usually severe and localising in the left lower quadrant, with any of the following: fever or sudden change in bowel habit and significant rectal bleeding or passage of mucus from the rectum or tenderness in the left lower quadrant, a palpable abdominal mass or distention on abdominal examination, with a previous history of diverticulosis or diverticulitis. […] 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.

• #4 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. […] There is no evidence that avoiding nuts, corn, or popcorn decreases the risk of diverticulosis or diverticular complications, such as diverticulitis. […] The differential diagnosis includes mechanical and inflammatory disorders of the gastrointestinal tract, urologic and gynecologic disorders, functional disorders, and malignancy. […] Patients often present with acute, constant abdominal pain that is usually in the left lower quadrant.

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

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

  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.

• #6 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.

• #7 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.

• #8 Diagnosing Diverticular Disease | NYU Langone Health

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

  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. Next, he or she may conduct one or more of the following tests. […] 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. […] The test can be used to diagnose diverticular disease in people who have symptoms.

• #9 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.

• #10 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. […] Offer intravenous antibiotics to people admitted to secondary care with suspected complicated acute diverticulitis. […] When prescribing an antibiotic for suspected or confirmed complicated acute diverticulitis, follow the advice in table 2.

• #11 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. […] In the acute phase of diverticulitis the extent of the extramural component of inflammation is more important than the degree of the intramural inflammation and as such CT associated with the use of intravenous and oral contrast and, in ideal conditions, rectal contrast is the gold standard means of investigation.

• #12 Diverticular disease – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/16

  Acute diverticulitis typically presents with left lower quadrant abdominal pain, often together with fever and leukocytosis. […] Laboratory test results are not consistently reliable and computed tomography scan is the imaging modality of choice for acute diverticulitis. […] Complications of acute diverticulitis most commonly include abscess, perforation, peritonitis, fistula formation, and obstruction, while segmental colitis, and chronic/smoldering diverticulitis, can also occur. […] Key diagnostic factors include left lower quadrant abdominal pain and fever. […] 1st tests to order include CBC with differential, CRP, basic metabolic panel, and contrast CT scan of abdomen. […] Tests to consider include blood culture, ABG and serum lactate, noncontrast CT scan of abdomen, abdominal ultrasound (graded-compression), abdominal MRI scan, colonoscopy or sigmoidoscopy, and diagnostic laparoscopy/exploratory laparotomy.

• #13 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. It is best to perform the scan with intravenous (IV) contrast when possible. […] 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.

• #14 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.

• #15 Diverticulitis Workup: Laboratory Studies, Imaging Studies, Procedures

  https://emedicine.medscape.com/article/173388-workup

  The diagnosis of acute diverticulitis can usually be made on the basis of the history and physical examination. Laboratory tests may be helpful when the diagnosis is in question. […] A computed tomography (CT) scan of the abdomen is considered the best imaging method to confirm the diagnosis. […] CT scans are preferred over intraluminal examinations (eg, barium enema), because the bulk of the inflammation is extraluminal. […] Endoscopy is not recommended in the acute setting given the risk of worsening diverticulitis and bowel perforation. […] Several staging schemes have been proposed for diverticulitis based on the clinical findings, disease extent on imaging studies, and the presence of complications. […] Clinical staging by Hinchey’s classification is based on computed tomography findings and directed toward selection of the proper surgical procedure when diverticulitis is complicated.

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

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

  Diverticular disease of the colon begins as diverticulosis (colonic outpouchings), which may develop into diverticulitis (diverticular inflammation and perforation). The cause of diverticulitis is probably mechanical. 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. 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. Alternative modalities recommended by the European Society of Coloproctology are ultrasonography and magnetic resonance imaging. 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 addition to using CT for the initial diagnosis, the American Gastroenterological Association (AGA) and ACR guidelines recommend CT scanning to identify complications of diverticulitis.

• #17 Diagnosing Diverticular Disease | NYU Langone Health

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

  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. Next, he or she may conduct one or more of the following tests. […] 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. […] The test can be used to diagnose diverticular disease in people who have symptoms.

• #18 POCUS for Diverticulitis — Kwak Talk

  https://kwaktalk.org/sono-sundays/diverticulitis

  Abdominal pain is one of if not the most common chief complaint presenting to the emergency room. […] In patients we suspect with diverticulitis, we may be able to use the point of care ultrasound to save patients from unnecessary radiation and as an easy and reliable way to get them appropriate treatment faster. […] Primary Outcome – Test characteristics of POCUS compared to CT for diagnosis of diverticulitis. […] Sensitivity 0.92 (0.880.96). […] Specificity 0.97 (0.940.99). […] Average US time: ~5 minutes. […] Thickened bowel wall appears to be most sensitive criteria. […] General consensus criteria for positive diagnosis: Diverticula: hypoechoic domed structure extending off of the colon. […] Bowel wall edema 4- 5 mm surrounding a diverticula. […] Enhancement/inflammation of pericolonic fat. […] Sonographic tenderness to palpation. […] Acute uncomplicated diverticulitis can be accurately and quickly diagnosed in the appropriate patient with point of care ultrasound. […] Consider sparing patients unnecessary radiation and wait times and pick up your trusty probe instead!

• #19 Diverticulitis – Wikipedia

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

  People with the above symptoms are commonly studied with computed tomography, or a CT scan. […] 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.

• #20 Diverticular Disease: Diagnosis and Treatment | AAFP

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

  CT with intravenous and oral contrast is the test of choice to confirm a suspected diagnosis of diverticulitis. […] The finding of pericolic fat infiltration is diagnostic. […] Although the sensitivity is excellent (97 percent), a normal CT does not preclude the diagnosis. […] 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. […] The severity of the inflammatory and infectious processes, as well as the underlying health of the patient, determines the appropriate treatment for patients with diverticulitis. […] In patients with uncomplicated diverticulitis who are clinically stable and able to tolerate fluids, outpatient treatment with broad-spectrum antibiotics covering anaerobes and gram-negative rods is appropriate.

• #21 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. […] Offer intravenous antibiotics to people admitted to secondary care with suspected complicated acute diverticulitis. […] When prescribing an antibiotic for suspected or confirmed complicated acute diverticulitis, follow the advice in table 2.

• #22 The WSES/SICG/ACOI/SICUT/AcEMC/SIFIPAC guidelines for diagnosis and treatment of acute left colonic diverticulitis in the elderly | World Journal of Emergency Surgery | Full Text

  https://wjes.biomedcentral.com/articles/10.1186/s13017-022-00408-0

  We suggest the use of CT-scan with IV-contrast in all elderly patients with suspected diverticulitis to confirm the diagnosis and to distinguish complicated from non-complicated diverticulitis. […] In elderly patients with suspected diverticulitis who cannot undergo CT-scan with IV-contrast (i.e. severe acute or chronic kidney disease or contrast allergy), we suggest the use of US, MRI or CT-scan without IV-contrast as alternative diagnostic approaches, according to resources availability. […] Hence, the importance of performing abdominal and pelvic CT scan with IV-contrast in all elderly patients with suspected ALCD (regardless of the value of leukocytes and of CRP) to exclude other diagnoses and to distinguish complicated from non-complicated diverticulitis, and to promptly plan the correct treatment.

• #23 Diagnosis of Diverticular Disease – NIDDK

  https://www.niddk.nih.gov/health-information/digestive-diseases/diverticulosis-diverticulitis/diagnosis

  To diagnose diverticular disease, doctors review your medical history, perform a physical exam, and order tests. […] Doctors may order blood tests, a stool test, imaging tests, and a colonoscopy to help diagnose diverticular disease. […] Doctors may use blood tests to check for signs of diverticulitis or its complications. […] Doctors may order a stool test to help find out if you have diverticular disease or another health problem, such as irritable bowel syndrome. […] Doctors typically diagnose diverticular disease with imaging tests, such as computed tomography (CT), ultrasound, and magnetic resonance imaging (MRI). […] Doctors may recommend a colonoscopy to confirm a diagnosis of diverticular disease and rule out other conditions, such as cancer.

• #24 The WSES/SICG/ACOI/SICUT/AcEMC/SIFIPAC guidelines for diagnosis and treatment of acute left colonic diverticulitis in the elderly | World Journal of Emergency Surgery | Full Text

  https://wjes.biomedcentral.com/articles/10.1186/s13017-022-00408-0

  We suggest the use of CT-scan with IV-contrast in all elderly patients with suspected diverticulitis to confirm the diagnosis and to distinguish complicated from non-complicated diverticulitis. […] In elderly patients with suspected diverticulitis who cannot undergo CT-scan with IV-contrast (i.e. severe acute or chronic kidney disease or contrast allergy), we suggest the use of US, MRI or CT-scan without IV-contrast as alternative diagnostic approaches, according to resources availability. […] Hence, the importance of performing abdominal and pelvic CT scan with IV-contrast in all elderly patients with suspected ALCD (regardless of the value of leukocytes and of CRP) to exclude other diagnoses and to distinguish complicated from non-complicated diverticulitis, and to promptly plan the correct treatment.

• #25 Ultrasound for Diverticulitis? | Emory School of Medicine

  https://med.emory.edu/departments/emergency-medicine/sections/ultrasound/case-of-the-month/abdominal/ultrasound_for_diverticulitis.html

  The image shows a bedside ultrasound used to diagnose an intraabdominal abscess in a patient with perforated diverticulitis. […] Studies in the hands of expert bowel sonographers show ultrasound has a sensitivity and specificity of 80% for the diagnosis of diverticulitis. Diagnosis is made by identifying the following findings: colonic wall 5mm thick, fat enhancement, evidence of abscess, visualized diverticuli, air artifacts suggesting diverticuli, and tenderness with compression of the probe. […] Ultrasound may be a useful tool in making an early bedside diagnosis or in cases where CT cannot be obtained.

• #26 Imaging for Diverticulitis | Ultrasound Solutions Corp.

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

  In the United States, computed tomography (CT) is the modality of choice in evaluating suspected diverticulitis as it is widely available, easy to perform, and accurate in diagnosis. […] Although CT imaging is considered the “gold standard” for the diagnosing diverticulitis in America, ultrasound is the preferred option in Europe, Asia, and Africa as the initial imaging modality in the evaluation of patients with suspected 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.

• #27 Diverticulitis – WikEM

  https://wikem.org/wiki/Diverticulitis

  Diverticulitis in the left lower quadrant as seen on axial view by a CT scan. CT demonstrating diverticulitis: edema and thickening of the sigmoid colon wall (arrow) with diverticulum and adjacent fat stranding. […] Labs […] Imaging […] CT with IV and PO contrast (Sn 97%, Sp 100%) […] Ultrasound (Sn 90%) […] MRI (Sn 98%, Sp 70-78%) […] Stable patient with history of confirmed diverticulitis does not require further diagnostic evaluation […] 1st time episode or current episode different from previous requires diagnostic imaging.

• #28 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.

• #29 Diverticulitis – Wikipedia

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

  People with the above symptoms are commonly studied with computed tomography, or a CT scan. […] 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.

• #30 Diverticulitis Workup: Laboratory Studies, Imaging Studies, Procedures

  https://emedicine.medscape.com/article/173388-workup

  The diagnosis of acute diverticulitis can usually be made on the basis of the history and physical examination. Laboratory tests may be helpful when the diagnosis is in question. […] A computed tomography (CT) scan of the abdomen is considered the best imaging method to confirm the diagnosis. […] CT scans are preferred over intraluminal examinations (eg, barium enema), because the bulk of the inflammation is extraluminal. […] Endoscopy is not recommended in the acute setting given the risk of worsening diverticulitis and bowel perforation. […] Several staging schemes have been proposed for diverticulitis based on the clinical findings, disease extent on imaging studies, and the presence of complications. […] Clinical staging by Hinchey’s classification is based on computed tomography findings and directed toward selection of the proper surgical procedure when diverticulitis is complicated.

• #31 Diverticulitis Workup: Laboratory Studies, Imaging Studies, Procedures

  https://emedicine.medscape.com/article/173388-workup

  The diagnosis of acute diverticulitis can usually be made on the basis of the history and physical examination. Laboratory tests may be helpful when the diagnosis is in question. […] A computed tomography (CT) scan of the abdomen is considered the best imaging method to confirm the diagnosis. […] CT scans are preferred over intraluminal examinations (eg, barium enema), because the bulk of the inflammation is extraluminal. […] Endoscopy is not recommended in the acute setting given the risk of worsening diverticulitis and bowel perforation. […] Several staging schemes have been proposed for diverticulitis based on the clinical findings, disease extent on imaging studies, and the presence of complications. […] Clinical staging by Hinchey’s classification is based on computed tomography findings and directed toward selection of the proper surgical procedure when diverticulitis is complicated.

• #32 Diagnosing Diverticular Disease | NYU Langone Health

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

  Your NYU Langone doctor may recommend a colonoscopy if he or she suspects you have diverticulosis. However, if you have symptoms of an infection, such as fever, chills, or nausea, your doctor does not need to perform this test until those symptoms resolve. The blood test and abdominal CT scan are all that are needed to confirm the diagnosis.

• #33 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.

• #34 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.

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

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

  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.

• #36 Diverticulitis: A Review of Diagnosis, Treatment, and Prevention | Consultant360

  https://www.consultant360.com/exclusive/consultant360/diverticulitis-review-diagnosis-treatment-and-prevention

  Diverticulitis is diagnosed clinically and radiologically. In the mid-20th century, diagnosis relied on barium enema, clinical presentation, or combination of the two. Radiographic findings include a paracolic mass, calcified fecalith, and distended loop near the bowel. Utilizing barium makes these findings all the more apparent. By the 1980s, computed tomography (CT) began being employed as the initial study for detecting diverticulitis. CT is more expensive but has a lower risk of perforation and can help diagnose extracolonic pathology. CT is 97% sensitive, making it the standard of care in the diagnosis of diverticulitis. […] Endoscopic examination is recommended 4 to 6 weeks after a course of diverticulitis to evaluate the colon, given that underlying neoplasia has been reported in 1% to 9.2% of cases. Newer evidence suggests that colonoscopy during hospitalization is safe so long as no pericolic air is present. Early colonoscopy during hospitalization yields better adherence but shows no clear benefit. Further literature yields colonoscopic evidence of neoplasm of 0.7% and 10.8% in uncomplicated and complicated diverticulitis, respectively, questioning the need for colonoscopy after uncomplicated diverticulitis. Endoscopic examination is still recommended 4 to 6 weeks after the resolution of diverticulitis.

• #37 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. […] Point-of-care ultrasound in an emergency department or urgent care facility could be an option for people with diverticulitis. […] Colonoscopy is often recommended 1 to 3 months after resolution of the episode to assess for cancer. However, in the absence of high-risk signs (eg, complicated diverticulitis, uncomplicated diverticulitis with imaging abnormalities or atypical course, family history of colorectal cancer, anemia, weight loss), the likelihood of malignant lesions or advanced adenomas after an episode of acute uncomplicated diverticulitis is low.

• #38 Diverticular disease practice points

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

  Diverticulitis can often be managed in the community by general practitioners, but the necessity of antibiotics may not be definitive. […] The preferred modality for diagnosis of diverticulitis is computed tomography (CT) with intravenous contrast. […] Following an acute presentation of diverticulitis, colonoscopy is generally undertaken to exclude neoplasia. […] Most gastroenterology and colorectal surgical publications recommend that patients presenting with CT-diagnosed diverticulitis should undergo colonoscopy to exclude malignancy. […] Overall, the available evidence suggests that while malignancy cannot be entirely excluded in all cases of uncomplicated CT-diagnosed diverticulitis, the risk of malignancy is low and routine interval colonoscopy in all patients is potentially not justified.

• #39 Diverticulitis Workup: Laboratory Studies, Imaging Studies, Procedures

  https://emedicine.medscape.com/article/173388-workup

  The diagnosis of acute diverticulitis can usually be made on the basis of the history and physical examination. Laboratory tests may be helpful when the diagnosis is in question. […] A computed tomography (CT) scan of the abdomen is considered the best imaging method to confirm the diagnosis. […] CT scans are preferred over intraluminal examinations (eg, barium enema), because the bulk of the inflammation is extraluminal. […] Endoscopy is not recommended in the acute setting given the risk of worsening diverticulitis and bowel perforation. […] Several staging schemes have been proposed for diverticulitis based on the clinical findings, disease extent on imaging studies, and the presence of complications. […] Clinical staging by Hinchey’s classification is based on computed tomography findings and directed toward selection of the proper surgical procedure when diverticulitis is complicated.

• #40 Surgical Management of Complicated Diverticulitis | IntechOpen

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

  Diverticular disease arises from the formation of small bulges or pockets, (diverticula), more frequently affecting the left and sigmoid colon in the western countries. […] 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.

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

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

  The guidelines for acute colonic diverticulitis were examined during a consensus conference of the World Society of Emergency Surgery (WSES), and final guidelines were published by Sartelli et al. The new classification system divided the disease into uncomplicated and complicated. Uncomplicated ACD was defined as only the presence of thickening of the intestinal wall, with increased perivisceral fat density. Complicated disease was divided into the following stages: Stage 1A: Presence of microperforation without abscess and/or peritoneum involvement; Stage 1B: Presence of abscess with diameter 4 cm; Stage 2A: Presence of abscess with diameter 4 cm; Stage 2B: Presence of distant air 5 cm from the pathologic loop; Stage 3: Presence of diffuse fluid in at least 2 distant abdominal quadrants without distant free air; Stage 4: Presence of diffuse fluid and distant free air.

• #42 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.

• #43 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. […] A randomized controlled trial including 50 patients found that starting oral antibiotics after clinical improvement with intravenous antibiotics resulted in shorter hospitalizations, greater cost savings, and no increased risk of recurrence compared with longer treatment with intravenous antibiotics. […] A study randomized 623 patients to antibiotics or placebo and found that antibiotic therapy for uncomplicated diverticulitis did not accelerate recovery, prevent complications, or prevent recurrence. […] Patients who present with symptoms consistent with recurrent diverticulitis warrant a complete evaluation. […] Studies have shown recurrence rates of diverticulitis from 9 to 36 percent. […] The decision to proceed to surgery should be individualized and based on patient preference, comorbidities, and lifestyle.

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

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

  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: consider a no antibiotic prescribing strategy, offer simple analgesia, for example paracetamol, advise the person to re-present if symptoms persist or worsen. […] Offer intravenous antibiotics to people admitted to secondary care with suspected complicated acute diverticulitis. […] The committee were unable to make recommendations for practice in this area. […] Do not offer an aminosalicylate or antibiotics to prevent recurrent acute diverticulitis.

• #45 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. […] There is no evidence that avoiding nuts, corn, or popcorn decreases the risk of diverticulosis or diverticular complications, such as diverticulitis. […] The differential diagnosis includes mechanical and inflammatory disorders of the gastrointestinal tract, urologic and gynecologic disorders, functional disorders, and malignancy. […] Patients often present with acute, constant abdominal pain that is usually in the left lower quadrant.

• #46 Diverticular Disease: Diagnosis and Treatment | AAFP

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

  Diverticular disease refers to symptomatic and asymptomatic disease with an underlying pathology of colonic diverticula. […] Symptomatic disease without inflammation is a diagnosis of exclusion requiring colonoscopy because imaging studies cannot discern the significance of diverticula. […] Computed tomography is recommended for diagnosis when inflammation is present. […] The diagnosis of symptomatic diverticular disease is one of exclusion in patients with diverticula. […] Consensus expert opinion recommends colonoscopy in all patients who present with symptomatic diverticular disease to exclude underlying neoplastic disease. […] The diagnosis of diverticulitis is suspected most often on the basis of clinical history and physical examination. […] Laboratory studies and imaging can be used judiciously to confirm a diagnosis of diverticulitis and to exclude other potential causes of similar symptoms.

• #47 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.

• #48 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). […] Diverticulitis is caused by an infection of one or more of the diverticula. […] Diverticulitis shares most of the symptoms of diverticular disease. However, the pain associated with diverticulitis is constant and severe, rather than intermittent. […] 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. A blood test may be taken, because a high number of white blood cells indicates infection. […] 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).

• #49 Colon Cancer After Acute Diverticulitis Treatment

  https://coloproctol.org/journal/view.php?doi=10.3393/ac.2013.29.4.167

  Diverticulitis is the most common clinical complication of diverticular disease, affecting 10-25% of the patients with diverticula. The prevalences of diverticulitis and colon cancer tend to increase with age and are higher in industrialized countries. Consequently, diverticulitis and colon cancer have been reported to have similar epidemiological characteristics. However, the relationship between these diseases remains controversial, as is the performance of routine colonoscopy after an episode of diverticulitis to exclude colon cancer. […] Although abdominal computed tomography (CT) is the most accurate method for diagnosing acute diverticulitis, its differentiation from colon cancer in the presence of complications, such as abscess and perforation, is difficult. Thus, whether a follow-up colonoscopy should be performed to detect colon cancer after treatment for acute diverticulitis, as well as whether such an investigation should be routine, remains controversial.

• #50 Colon Cancer After Acute Diverticulitis Treatment

  https://coloproctol.org/journal/view.php?doi=10.3393/ac.2013.29.4.167

  Recent studies showed no significant difference between the prevalence of colon cancer detected during colonoscopy after diverticulitis treatment to the prevalence of colon cancer in ordinary people. For reasons of cost, this has raised questions regarding the need for routine follow-up colonoscopy after treatment of acute diverticulitis. […] However, the diverticulitis treatment recommendations published in 2006 by the American Society of Colon and Rectal Surgeons include follow-up colonoscopy for the differentiation of colon cancer, ischemia, and inflammatory bowel diseases after recovery from acute diverticulitis. […] Therefore, colonoscopy is recommended approximately six weeks after diverticulitis treatment. […] However, in some cases, CT cannot differentiate other abdominal inflammatory diseases, infectious diseases, colon cancer, etc., due to technical error in the shooting, the anatomical state of the contracted colon, and nonspecific concurrent complications in the abdominal cavity, retroperitoneal organs, or abdominal wall.

• #51 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.

• #52 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.

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

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

  For people presenting in secondary care with complicated acute diverticulitis and suspected diverticular abscess, assess and manage in line with the NICE guideline on sepsis. […] Offer intravenous antibiotics to people with acute diverticulitis and suspected diverticular abscess. […] Offer a contrast CT scan to people with acute diverticulitis and suspected diverticular abscess. […] Offer either laparoscopic lavage or resectional surgery to people with diverticular perforation with generalised peritonitis after discussing the risks and benefits of the 2 options with them. […] Do not offer an aminosalicylate or antibiotics to prevent recurrent acute diverticulitis.

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

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

  Evidence for successful and economical outpatient treatment of uncomplicated diverticulitis is beginning to emerge. […] In a recent position statement from the Association of Coloproctology of Great Britain and Ireland (ASCPGBI) it was concluded that the majority of patients, whether young or old, presenting with acute diverticulitis could be managed with a conservative, medical approach in the longer term. […] 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. […] 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.

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

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

  For people presenting in secondary care with complicated acute diverticulitis and suspected diverticular abscess, assess and manage in line with the NICE guideline on sepsis. […] Offer intravenous antibiotics to people with acute diverticulitis and suspected diverticular abscess. […] Offer a contrast CT scan to people with acute diverticulitis and suspected diverticular abscess. […] Offer either laparoscopic lavage or resectional surgery to people with diverticular perforation with generalised peritonitis after discussing the risks and benefits of the 2 options with them. […] Do not offer an aminosalicylate or antibiotics to prevent recurrent acute diverticulitis.

• #56

  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.

• #57 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.

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

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

  The guidelines for acute colonic diverticulitis were examined during a consensus conference of the World Society of Emergency Surgery (WSES), and final guidelines were published by Sartelli et al. The new classification system divided the disease into uncomplicated and complicated. Uncomplicated ACD was defined as only the presence of thickening of the intestinal wall, with increased perivisceral fat density. Complicated disease was divided into the following stages: Stage 1A: Presence of microperforation without abscess and/or peritoneum involvement; Stage 1B: Presence of abscess with diameter 4 cm; Stage 2A: Presence of abscess with diameter 4 cm; Stage 2B: Presence of distant air 5 cm from the pathologic loop; Stage 3: Presence of diffuse fluid in at least 2 distant abdominal quadrants without distant free air; Stage 4: Presence of diffuse fluid and distant free air.

• #59 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.

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

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

  Do not offer antibiotics to people with diverticular disease. […] Advise people to avoid non-steroidal anti-inflammatory drugs and opioid analgesia if possible, because they may increase the risk of diverticular perforation. […] Suspect acute diverticulitis if a person presents with constant abdominal pain, usually severe and localising in the left lower quadrant, with any of the following: fever or sudden change in bowel habit and significant rectal bleeding or passage of mucus from the rectum or tenderness in the left lower quadrant, a palpable abdominal mass or distention on abdominal examination, with a previous history of diverticulosis or diverticulitis. […] 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.

• #61 Diverticulitis: a comprehensive review with usual and unusual complications | Insights into Imaging | Full Text

  https://insightsimaging.springeropen.com/articles/10.1007/s13244-016-0532-3

  Diverticulitis is characterized by inflammation of the outpouchings of the bowel wall. Imaging findings of diverticulitis include edematous thickening of the bowel wall with inflammatory changes within the adjacent mesenteric fat. […] MDCT is essential for the primary diagnosis of the acute diverticulitis and its complications. […] Computed tomography is the mainstay imaging technique in the diagnosis of diverticulitis and its complications. […] The diagnosis is generally straightforward with direct visualization of the endoluminal thrombus as a filling defect in the contrast filled mesenteric veins. […] CT is generally the first utilized modality in patients with diverticulitis with pylephlebitis. […] The clinical presentation of septic thrombophlebitis is insidious with vague symptoms, delaying early diagnosis and treatment.

• #62 Diverticulitis: a comprehensive review with usual and unusual complications | Insights into Imaging | Full Text

  https://insightsimaging.springeropen.com/articles/10.1007/s13244-016-0532-3

  The most helpful finding of diverticulitis is the detection of a diverticulum in the involved segment; however, colon cancer cannot be confidently excluded based on this finding, as diverticulosis without any active inflammation is also highly prevalent in the general population. […] Oral contrast should not be used in patients with a clinical suspicion of gastrointestinal bleeding on CT as it may obscure the active contrast extravasation from the eroded vessel. […] The rate of fistula formation is around 14 % after an episode of acute diverticulitis. […] MDCT is a very robust imaging tool for the primary diagnosis of the acute diverticulitis and its usual and unusual complications.

• #63 Diverticulitis: a comprehensive review with usual and unusual complications | Insights into Imaging | Full Text

  https://insightsimaging.springeropen.com/articles/10.1007/s13244-016-0532-3

  The most helpful finding of diverticulitis is the detection of a diverticulum in the involved segment; however, colon cancer cannot be confidently excluded based on this finding, as diverticulosis without any active inflammation is also highly prevalent in the general population. […] Oral contrast should not be used in patients with a clinical suspicion of gastrointestinal bleeding on CT as it may obscure the active contrast extravasation from the eroded vessel. […] The rate of fistula formation is around 14 % after an episode of acute diverticulitis. […] MDCT is a very robust imaging tool for the primary diagnosis of the acute diverticulitis and its usual and unusual complications.

• #64 Colonic Diverticulosis – Gastrointestinal Disorders – MSD Manual Professional Edition

  https://www.msdmanuals.com/professional/gastrointestinal-disorders/diverticular-disease/colonic-diverticulosis

  Diagnosis is by colonoscopy, capsule endoscopy, barium enema, CT, or MRI. […] Asymptomatic diverticula are usually found incidentally during colonoscopy, capsule endoscopy, barium enema, CT, or MRI. […] Lower GI bleeding due to diverticulosis is suspected when painless rectal bleeding develops, particularly in an older adult patient or in a patient who has a history of diverticular disease. Evaluation of lower GI bleeding typically includes colonoscopy, which can be done after rapid colonic preparation: 4 to 6 L of polyethylene glycol solution delivered orally, ideally via a nasogastric tube, and given over 3 to 4 hours until the rectal effluent is clear of blood and stool. […] If the source cannot be seen with colonoscopy and ongoing bleeding is sufficiently rapid ( 0.5 to 1 mL/minute), CT angiography or radionuclide imaging may localize the source.

• #65 Surgical Management of Complicated Diverticulitis | IntechOpen

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

  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. […] Based on this classification, most guidelines propose different approaches for each stage, which will be further discussed. […] An accurate diagnosis of diverticular bleeding involves a combination of clinical evaluation, endoscopic examination, and radiological studies. Endoscopy, specifically colonoscopy, is the gold standard for diagnosing diverticular bleeding and locating the bleeding source.

• #66 Colonic Diverticulosis – Gastrointestinal Disorders – MSD Manual Professional Edition

  https://www.msdmanuals.com/professional/gastrointestinal-disorders/diverticular-disease/colonic-diverticulosis

  A colonoscopy should be the first test performed after adequate colon preparation in patients with minor lower GI bleeding and in patients in whom bleeding has clinically ceased. […] Colonoscopic identification of stigmata of recent hemorrhage (active bleeding, adherent clot, dark spot, and a visible vessel) allows for endoscopic options to control bleeding, including epinephrine injection, application of endoclips or fibrin sealant, heater probe or bipolar coagulation, and band ligation. […] CT angiography should be performed initially in patients with ongoing hemodynamically significant lower GI bleeding; however, this test has low diagnostic yield in those with minor bleeding or no clinical evidence of continuing bleeding.

• #67 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.

• #68 Diverticulosis and Diverticulitis – Harvard Health

  https://www.health.harvard.edu/diseases-and-conditions/diverticulosis-and-diverticulitis-a-to-z

  For persistent or recurrent bleeding from diverticulosis, surgery may be the only option. […] After successful treatment for diverticulitis, your doctor normally will recommend a high-fiber diet. […] In general, surgery is not recommended after only one or even two attacks without complications. […] Repeated episodes of diverticulitis can lead to internal scarring and narrowing of the colon, which also may require surgery to remove a piece of the colon. […] With proper treatment and a high-fiber diet, the outlook for people with diverticulosis and uncomplicated diverticulitis is excellent. […] People who have diverticulitis usually improve within two to four days after treatment begins. […] The prognosis varies if complications develop and is particularly serious in the case of peritonitis.

• #69 Diverticulosis and Diverticulitis – Harvard Health

  https://www.health.harvard.edu/diseases-and-conditions/diverticulosis-and-diverticulitis-a-to-z

  For persistent or recurrent bleeding from diverticulosis, surgery may be the only option. […] After successful treatment for diverticulitis, your doctor normally will recommend a high-fiber diet. […] In general, surgery is not recommended after only one or even two attacks without complications. […] Repeated episodes of diverticulitis can lead to internal scarring and narrowing of the colon, which also may require surgery to remove a piece of the colon. […] With proper treatment and a high-fiber diet, the outlook for people with diverticulosis and uncomplicated diverticulitis is excellent. […] People who have diverticulitis usually improve within two to four days after treatment begins. […] The prognosis varies if complications develop and is particularly serious in the case of peritonitis.

• #70

  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.

• #71

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

  The diagnosis of diverticulitis can be challenging in primary care. […] A clinical diagnosis of diverticulitis can be made from patient history, a physical examination and laboratory testing. […] Patients with acute diverticulitis will most often present with new-onset abdominal pain, usually in the lower left quadrant. […] Patients who present with any of the following symptoms and signs are at risk of severe outcomes and require urgent referral to secondary care. […] Approximately 5% of patients with diverticulitis will develop complications such as perforation or abscess, usually within ten days of their initial presentation. […] The appropriate level of intervention for patients with acute diverticulitis is determined by their clinical condition and co-morbidities. […] Most recent international guidelines recommend conservative outpatient management, where appropriate; previous management strategies, e.g. antibiotic treatment for all patients with suspected diverticulitis, lacked clinical evidence. […] Community management without antibiotics requires appropriate patient follow-up. […] Some patients may experience recurrent or chronic episodes of diverticulitis. […] Patients with complicated, CT-proven diverticulitis require a colonoscopy to rule out cancer.

• #72 Diagnosis and Management of Acute Diverticulitis | AAFP

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

  A complete blood count should be obtained. […] A urinalysis is useful for ruling out urinary tract infection, and a human chorionic gonadotropin urine test should be considered in premenopausal women to exclude pregnancy. […] Measurement of C-reactive protein (CRP) should be considered. […] Abdominal CT is the test of choice in patients with suspected diverticulitis. […] Imaging is not necessary in most patients with mild symptoms. […] 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. […] The decision to hospitalize a patient with uncomplicated diverticulitis depends on several factors, including the patient’s ability to tolerate oral intake, severity of illness, comorbidities, and outpatient support systems.

• #73 Diverticular Disease: Diagnosis and Treatment | AAFP

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

  CT with intravenous and oral contrast is the test of choice to confirm a suspected diagnosis of diverticulitis. […] The finding of pericolic fat infiltration is diagnostic. […] Although the sensitivity is excellent (97 percent), a normal CT does not preclude the diagnosis. […] 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. […] The severity of the inflammatory and infectious processes, as well as the underlying health of the patient, determines the appropriate treatment for patients with diverticulitis. […] In patients with uncomplicated diverticulitis who are clinically stable and able to tolerate fluids, outpatient treatment with broad-spectrum antibiotics covering anaerobes and gram-negative rods is appropriate.

• #74

  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.

• #75

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

  The diagnosis of diverticulitis can be challenging in primary care. […] A clinical diagnosis of diverticulitis can be made from patient history, a physical examination and laboratory testing. […] Patients with acute diverticulitis will most often present with new-onset abdominal pain, usually in the lower left quadrant. […] Patients who present with any of the following symptoms and signs are at risk of severe outcomes and require urgent referral to secondary care. […] Approximately 5% of patients with diverticulitis will develop complications such as perforation or abscess, usually within ten days of their initial presentation. […] The appropriate level of intervention for patients with acute diverticulitis is determined by their clinical condition and co-morbidities. […] Most recent international guidelines recommend conservative outpatient management, where appropriate; previous management strategies, e.g. antibiotic treatment for all patients with suspected diverticulitis, lacked clinical evidence. […] Community management without antibiotics requires appropriate patient follow-up. […] Some patients may experience recurrent or chronic episodes of diverticulitis. […] Patients with complicated, CT-proven diverticulitis require a colonoscopy to rule out cancer.

• #76 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.

• #77 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. […] Offer intravenous antibiotics to people admitted to secondary care with suspected complicated acute diverticulitis. […] When prescribing an antibiotic for suspected or confirmed complicated acute diverticulitis, follow the advice in table 2.

• #78 The WSES/SICG/ACOI/SICUT/AcEMC/SIFIPAC guidelines for diagnosis and treatment of acute left colonic diverticulitis in the elderly | World Journal of Emergency Surgery | Full Text

  https://wjes.biomedcentral.com/articles/10.1186/s13017-022-00408-0

  Statement 1.1 In the elderly population, we suggest against basing the diagnosis of acute left colonic diverticulitis on only patient clinical signs, symptoms and laboratory tests. […] Statement 1.2 We suggest that elderly patients presenting with abdominal guarding or pain in the lower left abdomen on physical examination undergo appropriate imaging for suspected diverticulitis, regardless of the value of leukocytes and of C-reactive protein (CRP). […] As stated in the WSES Guidelines in the general population, the clinical diagnosis of ALCD alone is not sufficiently accurate for patients with suspected diverticulitis. […] The reported sensitivity and specificity of the clinical diagnosis of ALCD in the general population are 0.68 and 0.98, respectively. […] Focusing on elderly patients, as previously reported, the clinical presentation of ALCD is more nuanced. Only 50% of patients older than 65 years with ALCD have pain in the lower quadrants of the abdomen, with only 17% having fever and 43% do not have a leucocytosis.

• #79 The WSES/SICG/ACOI/SICUT/AcEMC/SIFIPAC guidelines for diagnosis and treatment of acute left colonic diverticulitis in the elderly | World Journal of Emergency Surgery | Full Text

  https://wjes.biomedcentral.com/articles/10.1186/s13017-022-00408-0

  We suggest the use of CT-scan with IV-contrast in all elderly patients with suspected diverticulitis to confirm the diagnosis and to distinguish complicated from non-complicated diverticulitis. […] In elderly patients with suspected diverticulitis who cannot undergo CT-scan with IV-contrast (i.e. severe acute or chronic kidney disease or contrast allergy), we suggest the use of US, MRI or CT-scan without IV-contrast as alternative diagnostic approaches, according to resources availability. […] Hence, the importance of performing abdominal and pelvic CT scan with IV-contrast in all elderly patients with suspected ALCD (regardless of the value of leukocytes and of CRP) to exclude other diagnoses and to distinguish complicated from non-complicated diverticulitis, and to promptly plan the correct treatment.

• #80 The WSES/SICG/ACOI/SICUT/AcEMC/SIFIPAC guidelines for diagnosis and treatment of acute left colonic diverticulitis in the elderly | World Journal of Emergency Surgery | Full Text

  https://wjes.biomedcentral.com/articles/10.1186/s13017-022-00408-0

  Statement 1.1 In the elderly population, we suggest against basing the diagnosis of acute left colonic diverticulitis on only patient clinical signs, symptoms and laboratory tests. […] Statement 1.2 We suggest that elderly patients presenting with abdominal guarding or pain in the lower left abdomen on physical examination undergo appropriate imaging for suspected diverticulitis, regardless of the value of leukocytes and of C-reactive protein (CRP). […] As stated in the WSES Guidelines in the general population, the clinical diagnosis of ALCD alone is not sufficiently accurate for patients with suspected diverticulitis. […] The reported sensitivity and specificity of the clinical diagnosis of ALCD in the general population are 0.68 and 0.98, respectively. […] Focusing on elderly patients, as previously reported, the clinical presentation of ALCD is more nuanced. Only 50% of patients older than 65 years with ALCD have pain in the lower quadrants of the abdomen, with only 17% having fever and 43% do not have a leucocytosis.

• #81

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

  The diagnosis of diverticulitis can be challenging in primary care. […] A clinical diagnosis of diverticulitis can be made from patient history, a physical examination and laboratory testing. […] Patients with acute diverticulitis will most often present with new-onset abdominal pain, usually in the lower left quadrant. […] Patients who present with any of the following symptoms and signs are at risk of severe outcomes and require urgent referral to secondary care. […] Approximately 5% of patients with diverticulitis will develop complications such as perforation or abscess, usually within ten days of their initial presentation. […] The appropriate level of intervention for patients with acute diverticulitis is determined by their clinical condition and co-morbidities. […] Most recent international guidelines recommend conservative outpatient management, where appropriate; previous management strategies, e.g. antibiotic treatment for all patients with suspected diverticulitis, lacked clinical evidence. […] Community management without antibiotics requires appropriate patient follow-up. […] Some patients may experience recurrent or chronic episodes of diverticulitis. […] Patients with complicated, CT-proven diverticulitis require a colonoscopy to rule out cancer.

• #82 The WSES/SICG/ACOI/SICUT/AcEMC/SIFIPAC guidelines for diagnosis and treatment of acute left colonic diverticulitis in the elderly | World Journal of Emergency Surgery | Full Text

  https://wjes.biomedcentral.com/articles/10.1186/s13017-022-00408-0

  Statement 1.1 In the elderly population, we suggest against basing the diagnosis of acute left colonic diverticulitis on only patient clinical signs, symptoms and laboratory tests. […] Statement 1.2 We suggest that elderly patients presenting with abdominal guarding or pain in the lower left abdomen on physical examination undergo appropriate imaging for suspected diverticulitis, regardless of the value of leukocytes and of C-reactive protein (CRP). […] As stated in the WSES Guidelines in the general population, the clinical diagnosis of ALCD alone is not sufficiently accurate for patients with suspected diverticulitis. […] The reported sensitivity and specificity of the clinical diagnosis of ALCD in the general population are 0.68 and 0.98, respectively. […] Focusing on elderly patients, as previously reported, the clinical presentation of ALCD is more nuanced. Only 50% of patients older than 65 years with ALCD have pain in the lower quadrants of the abdomen, with only 17% having fever and 43% do not have a leucocytosis.

• #83 The WSES/SICG/ACOI/SICUT/AcEMC/SIFIPAC guidelines for diagnosis and treatment of acute left colonic diverticulitis in the elderly | World Journal of Emergency Surgery | Full Text

  https://wjes.biomedcentral.com/articles/10.1186/s13017-022-00408-0

  We suggest the use of CT-scan with IV-contrast in all elderly patients with suspected diverticulitis to confirm the diagnosis and to distinguish complicated from non-complicated diverticulitis. […] In elderly patients with suspected diverticulitis who cannot undergo CT-scan with IV-contrast (i.e. severe acute or chronic kidney disease or contrast allergy), we suggest the use of US, MRI or CT-scan without IV-contrast as alternative diagnostic approaches, according to resources availability. […] Hence, the importance of performing abdominal and pelvic CT scan with IV-contrast in all elderly patients with suspected ALCD (regardless of the value of leukocytes and of CRP) to exclude other diagnoses and to distinguish complicated from non-complicated diverticulitis, and to promptly plan the correct treatment.

• #84 Diverticulitis: Symptoms, Causes & Treatment

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

  If conservative at-home treatment hasnt worked, or if you have severe, chronic or complicated diverticulitis, you may need to stay in the hospital for treatment. Treatment may include: IV medication. Your provider may give you antibiotics or antivirals through an IV line so that the medicine goes directly to your bloodstream. They may also give you pain relief this way. Some people may need strong analgesics, such as opioids. […] If diet and lifestyle improvements havent prevented diverticulitis from recurring, there might be other factors involved that put you more at risk. People with weakened immune systems are more prone to frequent infections and slower to recover. People with autoimmune diseases are more likely to have chronic inflammation. Even the balance of different bacteria living in your gut may affect your gut immunity.

• #85 Diverticulitis Diagnosis: Testing and Similar Conditions

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

  The diagnostic process for diverticulitis often begins with going to a healthcare provider with symptoms such as abdominal pain, constipation or diarrhea, and fever. However, these are common to many other conditions. […] Further diagnostic procedures may involve blood, urine, stool, and imaging tests. […] A healthcare provider may use one or more tests to confirm or rule out a diagnosis of diverticulitis. […] A blood test that measures C-reactive protein (CRP) may be helpful in diagnosing diverticulitis. […] A urine test won’t be able to diagnose diverticulitis. […] A digital rectal exam is a test used to feel inside the rectum for abnormalities. […] A stool test may be done to help rule out other potential reasons for digestive symptoms, such as an infection. […] A computed tomography (CT) scan is a test that is used frequently to diagnose diverticulitis.

• #86 Imaging for Diverticulitis | Ultrasound Solutions Corp.

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

  In the United States, computed tomography (CT) is the modality of choice in evaluating suspected diverticulitis as it is widely available, easy to perform, and accurate in diagnosis. […] Although CT imaging is considered the “gold standard” for the diagnosing diverticulitis in America, ultrasound is the preferred option in Europe, Asia, and Africa as the initial imaging modality in the evaluation of patients with suspected 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.

• #87 Diverticulitis: A Review of Diagnosis, Treatment, and Prevention | Consultant360

  https://www.consultant360.com/exclusive/consultant360/diverticulitis-review-diagnosis-treatment-and-prevention

  Diverticulitis is diagnosed clinically and radiologically. In the mid-20th century, diagnosis relied on barium enema, clinical presentation, or combination of the two. Radiographic findings include a paracolic mass, calcified fecalith, and distended loop near the bowel. Utilizing barium makes these findings all the more apparent. By the 1980s, computed tomography (CT) began being employed as the initial study for detecting diverticulitis. CT is more expensive but has a lower risk of perforation and can help diagnose extracolonic pathology. CT is 97% sensitive, making it the standard of care in the diagnosis of diverticulitis. […] Endoscopic examination is recommended 4 to 6 weeks after a course of diverticulitis to evaluate the colon, given that underlying neoplasia has been reported in 1% to 9.2% of cases. Newer evidence suggests that colonoscopy during hospitalization is safe so long as no pericolic air is present. Early colonoscopy during hospitalization yields better adherence but shows no clear benefit. Further literature yields colonoscopic evidence of neoplasm of 0.7% and 10.8% in uncomplicated and complicated diverticulitis, respectively, questioning the need for colonoscopy after uncomplicated diverticulitis. Endoscopic examination is still recommended 4 to 6 weeks after the resolution of diverticulitis.

• #88 POCUS for Diverticulitis — Kwak Talk

  https://kwaktalk.org/sono-sundays/diverticulitis

  Abdominal pain is one of if not the most common chief complaint presenting to the emergency room. […] In patients we suspect with diverticulitis, we may be able to use the point of care ultrasound to save patients from unnecessary radiation and as an easy and reliable way to get them appropriate treatment faster. […] Primary Outcome – Test characteristics of POCUS compared to CT for diagnosis of diverticulitis. […] Sensitivity 0.92 (0.880.96). […] Specificity 0.97 (0.940.99). […] Average US time: ~5 minutes. […] Thickened bowel wall appears to be most sensitive criteria. […] General consensus criteria for positive diagnosis: Diverticula: hypoechoic domed structure extending off of the colon. […] Bowel wall edema 4- 5 mm surrounding a diverticula. […] Enhancement/inflammation of pericolonic fat. […] Sonographic tenderness to palpation. […] Acute uncomplicated diverticulitis can be accurately and quickly diagnosed in the appropriate patient with point of care ultrasound. […] Consider sparing patients unnecessary radiation and wait times and pick up your trusty probe instead!

• #89 Acute Diverticulitis: US Diagnosis and Staging | SpringerLink

  https://link.springer.com/chapter/10.1007/978-3-031-40231-9_5

  Acute diverticulitis is a common condition requiring imaging confirmation and description to tailor further therapeutic management. […] Although CT scanning is still the preferred imaging investigation, US has gained increased momentum as it is non-invasive, inexpensive, easy to use, and readily available. […] In acute diverticulitis, US is particularly attractive because it allows definition of the extent of extra-mucosal inflammatory masses as well as the identification of abscesses, with good sensitivity and specificity. […] In this context, US should be used as first imaging modality for patients presenting with acute abdominal pain, reserving CT for inconclusive/negative findings (i.e., too much fat, too much gas, or too much pain) or when the disease is partially located into the pelvis, where US could not be accurate enough.

• #90 POCUS for Diverticulitis — Kwak Talk

  https://kwaktalk.org/sono-sundays/diverticulitis

  Abdominal pain is one of if not the most common chief complaint presenting to the emergency room. […] In patients we suspect with diverticulitis, we may be able to use the point of care ultrasound to save patients from unnecessary radiation and as an easy and reliable way to get them appropriate treatment faster. […] Primary Outcome – Test characteristics of POCUS compared to CT for diagnosis of diverticulitis. […] Sensitivity 0.92 (0.880.96). […] Specificity 0.97 (0.940.99). […] Average US time: ~5 minutes. […] Thickened bowel wall appears to be most sensitive criteria. […] General consensus criteria for positive diagnosis: Diverticula: hypoechoic domed structure extending off of the colon. […] Bowel wall edema 4- 5 mm surrounding a diverticula. […] Enhancement/inflammation of pericolonic fat. […] Sonographic tenderness to palpation. […] Acute uncomplicated diverticulitis can be accurately and quickly diagnosed in the appropriate patient with point of care ultrasound. […] Consider sparing patients unnecessary radiation and wait times and pick up your trusty probe instead!

• #91 Ultrasound for Diverticulitis? | Emory School of Medicine

  https://med.emory.edu/departments/emergency-medicine/sections/ultrasound/case-of-the-month/abdominal/ultrasound_for_diverticulitis.html

  The image shows a bedside ultrasound used to diagnose an intraabdominal abscess in a patient with perforated diverticulitis. […] Studies in the hands of expert bowel sonographers show ultrasound has a sensitivity and specificity of 80% for the diagnosis of diverticulitis. Diagnosis is made by identifying the following findings: colonic wall 5mm thick, fat enhancement, evidence of abscess, visualized diverticuli, air artifacts suggesting diverticuli, and tenderness with compression of the probe. […] Ultrasound may be a useful tool in making an early bedside diagnosis or in cases where CT cannot be obtained.

• #92 Imaging for Diverticulitis | Ultrasound Solutions Corp.

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

  In the United States, computed tomography (CT) is the modality of choice in evaluating suspected diverticulitis as it is widely available, easy to perform, and accurate in diagnosis. […] Although CT imaging is considered the “gold standard” for the diagnosing diverticulitis in America, ultrasound is the preferred option in Europe, Asia, and Africa as the initial imaging modality in the evaluation of patients with suspected 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.

• #93 Is Colonoscopy Necessary after Computed Tomography Diagnosis of Acute Diverticulitis?

  https://www.irjournal.org/journal/view.php?doi=10.5217/ir.2014.12.3.221

  A diagnosis of acute diverticulitis is based on computed tomography (CT). Colonoscopy is commonly performed after the acute event to exclude other diagnoses. […] Routine colonoscopy yields little benefit in patients with acute diverticulitis diagnosed by typical clinical symptoms and CT. The current practice of a colonoscopy after acute diverticulitis needs to be reevaluated. […] Although CT is currently the most appropriate diagnostic imaging tool for diverticulitis, colonoscopy is commonly performed after an acute diverticulitis episode to exclude other infectious, inflammatory, or neoplastic diseases. […] Recent studies to determine the yield of colonoscopy in diverticulitis cases suggested that routine colonoscopy after acute diverticulitis-diagnosed by typical clinical symptoms and CT findings-needs to be reevaluated. […] In conclusion, routine colonoscopy yields little benefit in patients with acute diverticulitis and more refined criteria should be developed. The use of colonoscopy should be limited to situations in which the diagnosis of diverticulitis is unclear.

• #94 Colon Cancer After Acute Diverticulitis Treatment

  https://coloproctol.org/journal/view.php?doi=10.3393/ac.2013.29.4.167

  Diverticulitis is the most common clinical complication of diverticular disease, affecting 10-25% of the patients with diverticula. The prevalences of diverticulitis and colon cancer tend to increase with age and are higher in industrialized countries. Consequently, diverticulitis and colon cancer have been reported to have similar epidemiological characteristics. However, the relationship between these diseases remains controversial, as is the performance of routine colonoscopy after an episode of diverticulitis to exclude colon cancer. […] Although abdominal computed tomography (CT) is the most accurate method for diagnosing acute diverticulitis, its differentiation from colon cancer in the presence of complications, such as abscess and perforation, is difficult. Thus, whether a follow-up colonoscopy should be performed to detect colon cancer after treatment for acute diverticulitis, as well as whether such an investigation should be routine, remains controversial.

• #95 Diverticular disease practice points

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

  Diverticulitis can often be managed in the community by general practitioners, but the necessity of antibiotics may not be definitive. […] The preferred modality for diagnosis of diverticulitis is computed tomography (CT) with intravenous contrast. […] Following an acute presentation of diverticulitis, colonoscopy is generally undertaken to exclude neoplasia. […] Most gastroenterology and colorectal surgical publications recommend that patients presenting with CT-diagnosed diverticulitis should undergo colonoscopy to exclude malignancy. […] Overall, the available evidence suggests that while malignancy cannot be entirely excluded in all cases of uncomplicated CT-diagnosed diverticulitis, the risk of malignancy is low and routine interval colonoscopy in all patients is potentially not justified.

• #96 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.

• #97 Diverticulitis: A Review of Diagnosis, Treatment, and Prevention | Consultant360

  https://www.consultant360.com/exclusive/consultant360/diverticulitis-review-diagnosis-treatment-and-prevention

  Diverticulitis is diagnosed clinically and radiologically. In the mid-20th century, diagnosis relied on barium enema, clinical presentation, or combination of the two. Radiographic findings include a paracolic mass, calcified fecalith, and distended loop near the bowel. Utilizing barium makes these findings all the more apparent. By the 1980s, computed tomography (CT) began being employed as the initial study for detecting diverticulitis. CT is more expensive but has a lower risk of perforation and can help diagnose extracolonic pathology. CT is 97% sensitive, making it the standard of care in the diagnosis of diverticulitis. […] Endoscopic examination is recommended 4 to 6 weeks after a course of diverticulitis to evaluate the colon, given that underlying neoplasia has been reported in 1% to 9.2% of cases. Newer evidence suggests that colonoscopy during hospitalization is safe so long as no pericolic air is present. Early colonoscopy during hospitalization yields better adherence but shows no clear benefit. Further literature yields colonoscopic evidence of neoplasm of 0.7% and 10.8% in uncomplicated and complicated diverticulitis, respectively, questioning the need for colonoscopy after uncomplicated diverticulitis. Endoscopic examination is still recommended 4 to 6 weeks after the resolution of diverticulitis.

• #98 Colon Cancer After Acute Diverticulitis Treatment

  https://coloproctol.org/journal/view.php?doi=10.3393/ac.2013.29.4.167

  Recent studies showed no significant difference between the prevalence of colon cancer detected during colonoscopy after diverticulitis treatment to the prevalence of colon cancer in ordinary people. For reasons of cost, this has raised questions regarding the need for routine follow-up colonoscopy after treatment of acute diverticulitis. […] However, the diverticulitis treatment recommendations published in 2006 by the American Society of Colon and Rectal Surgeons include follow-up colonoscopy for the differentiation of colon cancer, ischemia, and inflammatory bowel diseases after recovery from acute diverticulitis. […] Therefore, colonoscopy is recommended approximately six weeks after diverticulitis treatment. […] However, in some cases, CT cannot differentiate other abdominal inflammatory diseases, infectious diseases, colon cancer, etc., due to technical error in the shooting, the anatomical state of the contracted colon, and nonspecific concurrent complications in the abdominal cavity, retroperitoneal organs, or abdominal wall.

• #99 Acute Diverticulitis: US Diagnosis and Staging | SpringerLink

  https://link.springer.com/chapter/10.1007/978-3-031-40231-9_5

  Acute diverticulitis is a common condition requiring imaging confirmation and description to tailor further therapeutic management. […] Although CT scanning is still the preferred imaging investigation, US has gained increased momentum as it is non-invasive, inexpensive, easy to use, and readily available. […] In acute diverticulitis, US is particularly attractive because it allows definition of the extent of extra-mucosal inflammatory masses as well as the identification of abscesses, with good sensitivity and specificity. […] In this context, US should be used as first imaging modality for patients presenting with acute abdominal pain, reserving CT for inconclusive/negative findings (i.e., too much fat, too much gas, or too much pain) or when the disease is partially located into the pelvis, where US could not be accurate enough.

• #100

  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.

• #101 Imaging for Diverticulitis | Ultrasound Solutions Corp.

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

  In the United States, computed tomography (CT) is the modality of choice in evaluating suspected diverticulitis as it is widely available, easy to perform, and accurate in diagnosis. […] Although CT imaging is considered the “gold standard” for the diagnosing diverticulitis in America, ultrasound is the preferred option in Europe, Asia, and Africa as the initial imaging modality in the evaluation of patients with suspected 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.

• #102 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. It is best to perform the scan with intravenous (IV) contrast when possible. […] 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.

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

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

  Diverticular disease of the colon begins as diverticulosis (colonic outpouchings), which may develop into diverticulitis (diverticular inflammation and perforation). The cause of diverticulitis is probably mechanical. 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. 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. Alternative modalities recommended by the European Society of Coloproctology are ultrasonography and magnetic resonance imaging. 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 addition to using CT for the initial diagnosis, the American Gastroenterological Association (AGA) and ACR guidelines recommend CT scanning to identify complications of diverticulitis.

• #104 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.

• #105 Diagnosing Diverticular Disease | NYU Langone Health

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

  Your NYU Langone doctor may recommend a colonoscopy if he or she suspects you have diverticulosis. However, if you have symptoms of an infection, such as fever, chills, or nausea, your doctor does not need to perform this test until those symptoms resolve. The blood test and abdominal CT scan are all that are needed to confirm the diagnosis.

• #106 Imaging for Diverticulitis | Ultrasound Solutions Corp.

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

  In the United States, computed tomography (CT) is the modality of choice in evaluating suspected diverticulitis as it is widely available, easy to perform, and accurate in diagnosis. […] Although CT imaging is considered the “gold standard” for the diagnosing diverticulitis in America, ultrasound is the preferred option in Europe, Asia, and Africa as the initial imaging modality in the evaluation of patients with suspected 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.

• #107 POCUS for Diverticulitis — Kwak Talk

  https://kwaktalk.org/sono-sundays/diverticulitis

  Abdominal pain is one of if not the most common chief complaint presenting to the emergency room. […] In patients we suspect with diverticulitis, we may be able to use the point of care ultrasound to save patients from unnecessary radiation and as an easy and reliable way to get them appropriate treatment faster. […] Primary Outcome – Test characteristics of POCUS compared to CT for diagnosis of diverticulitis. […] Sensitivity 0.92 (0.880.96). […] Specificity 0.97 (0.940.99). […] Average US time: ~5 minutes. […] Thickened bowel wall appears to be most sensitive criteria. […] General consensus criteria for positive diagnosis: Diverticula: hypoechoic domed structure extending off of the colon. […] Bowel wall edema 4- 5 mm surrounding a diverticula. […] Enhancement/inflammation of pericolonic fat. […] Sonographic tenderness to palpation. […] Acute uncomplicated diverticulitis can be accurately and quickly diagnosed in the appropriate patient with point of care ultrasound. […] Consider sparing patients unnecessary radiation and wait times and pick up your trusty probe instead!

• #108 Diagnosis and treatment of colonic diverticulitis

  https://jbcr.arphahub.com/article/144785/

  Nasze wyniki przekonująco pokazują, że indywidualne i odpowiednie leczenie zachowawcze oraz chirurgiczne pacjentów z ostrym i przewlekłym zapaleniem uchyłków jelita grubego, oparte na terminowej i precyzyjnej diagnostyce laboratoryjnej i obrazowej, jest wystarczająco bezpieczne i skuteczne.

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

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

  Evidence for successful and economical outpatient treatment of uncomplicated diverticulitis is beginning to emerge. […] In a recent position statement from the Association of Coloproctology of Great Britain and Ireland (ASCPGBI) it was concluded that the majority of patients, whether young or old, presenting with acute diverticulitis could be managed with a conservative, medical approach in the longer term. […] 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. […] 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.

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