Emergency medicine updates: Acute diverticulitis - 19/01/24

Doi : 10.1016/j.ajem.2023.10.051

Brit Long, MD ^a,^{^⁎} , Jessie Werner, MD ^b, Michael Gottlieb, MD ^c
^a Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, TX, USA
^b Department of Emergency Medicine, UCSF Fresno, Fresno, CA, USA
^c Department of Emergency Medicine, Rush University Medical Center, Chicago, IL, USA

^⁎Corresponding author at: 3551 Roger Brooke Dr, Fort Sam Houston, TX 78234.3551 Roger Brooke DrFort Sam HoustonTX78234

Abstract

Introduction

Acute diverticulitis is a condition commonly seen in the emergency department (ED). Therefore, it is important for emergency medicine clinicians to be aware of the current evidence regarding the diagnosis and management of this disease.

Objective

This paper evaluates key evidence-based updates concerning acute diverticulitis for the emergency clinician.

Discussion

Diverticulitis is a complication of diverticulosis and most commonly affects the sigmoid and descending colon in Western countries. History and examination can suggest the diagnosis, with abdominal pain and tenderness in the left lower quadrant being the most common symptom and sign, respectively. Change in bowel habits and fever may also occur. Laboratory testing may demonstrate leukocytosis or an elevated C-reactive protein. Imaging options can include computed tomography (CT) of the abdomen and pelvis with intravenous contrast, magnetic resonance imaging (MRI), or ultrasound (US), though most classification systems for diverticulitis incorporate CT findings. While the majority of diverticulitis cases are uncomplicated, complications may affect up to 25% of patients. Treatment of complicated diverticulitis requires antibiotics and surgical consultation. Antibiotics are not required in select patients with uncomplicated diverticulitis. Appropriate patients for supportive care without antibiotics should be well-appearing, have pain adequately controlled, be able to tolerate oral intake, be able to follow up, have no complications, and have no immunocompromise or severe comorbidities.