Diverticulitis Follow-up

  • Author: Minh Chau T Nguyen, MD; Chief Editor: Julian Katz, MD   more...
 
Updated: Sep 22, 2011
 

Further Inpatient Care

  • Emergency colectomy is performed when severe complications arise or when the patient does not respond to medical treatment. Complications requiring surgical intervention include the following: purulent peritonitis, uncontrolled sepsis, fistula, and obstruction. In one retrospective study of over 3000 patients, about 20% of patients admitted for acute diverticulitis required emergency colectomy.
  • Elective resection of the involved bowel segment after 2 episodes of uncomplicated diverticulitis to prevent further attacks has been advocated for years. In addition, earlier resection for younger patients with diverticulitis as well as for patients who are immunocompromised has been proposed. As most complicated diverticulitis occurs on the first presentation and data for elective resection have come from small retrospective studies, this recommendation remains controversial.
  • Successful percutaneous drainage of a diverticular abscess has not been associated with greater recurrence or more severe disease and does not necessitate elective colectomy.
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Further Outpatient Care

  • After recovering from acute diverticulitis, patients should have their colons examined to rule out malignancy. Current modalities include colonoscopy, barium enema, and CT colography (virtual colonoscopy).
    • Biopsy of suspicious lesions or strictures can be performed during colonoscopy, which is advantageous.
    • Virtual colonoscopy may be helpful in evaluating diverticulitis in the elective setting. This procedure combines insufflation of the colon in conjunction with a CT scan to provide data that allow computer generation of a 3-dimensional image. At this time, though, the technology is not widely available and does not allow sampling of suspicious lesions.
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Deterrence/Prevention

  • A lifelong high-fiber diet for those with asymptomatic diverticular disease may reduce the incidence of diverticulitis and its complications.
  • According to a large study in the United Kingdom, a high-fiber diet and a vegetarian diet were each significantly associated with lower risk of diverticular disease-related hospital admission or death.[9]
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Complications

  • Abscess
  • Intestinal fistula
  • Intestinal perforation
  • Intestinal obstruction
  • Peritonitis
  • Sepsis and septic shock
  • Diverticular bleeding (more common in diverticulosis than diverticulitis)
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Prognosis

  • Prognosis depends on the severity of illness, the presence of complications, and any coexisting medical problems. Younger patients with diverticulitis may have more severe disease, possibly due to a delay in diagnosis and treatment.
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Patient Education

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Contributor Information and Disclosures
Author

Minh Chau T Nguyen, MD  Assistant Clinical Professor of Medicine, University of California, Los Angeles, David Geffen School of Medicine, Olive View-UCLA Medical Center

Disclosure: Nothing to disclose.

Coauthor(s)

Yuvrajsinh Narendrasinh Chudasama, MD  Staff Physician, Department of Internal Medicine, Olive View-UCLA Medical Center; Assistant Clinical Professor of Medicine, University of California, Los Angeles, David Geffen School of Medicine

Yuvrajsinh Narendrasinh Chudasama, MD is a member of the following medical societies: American College of Physicians and American Medical Association

Disclosure: Nothing to disclose.

Stanley K Dea, MD  Chief of Endoscopy, Acting Chief of Gastroenterology, Consulting Gastroenterologist Olive View-University of California at Los Angeles Medical Center; Director of Enteral Feeding, West Los Angeles Veterans Affairs Medical Center; Director of Endoscopic Training, University of California at Los Angeles Affiliated Training Program in Gastroenterology

Stanley K Dea, MD is a member of the following medical societies: American Society for Gastrointestinal Endoscopy and Southern California Society of Gastroenterology

Disclosure: Nothing to disclose.

Andrea Cooperman, MD  Assistant Clinical Professor of Medicine, David Geffen School of Medicine at UCLA, Olive View-UCLA Medical Center

Andrea Cooperman, MD is a member of the following medical societies: Alpha Omega Alpha and Society of General Internal Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Waqar A Qureshi, MD  Associate Professor of Medicine, Chief of Endoscopy, Department of Internal Medicine, Division of Gastroenterology, Baylor College of Medicine and Veterans Affairs Medical Center

Waqar A Qureshi, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, and American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

BS Anand, MD  Professor, Department of Internal Medicine, Division of Gastroenterology, Baylor College of Medicine

BS Anand, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, American Gastroenterological Association, and American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Alex J Mechaber, MD, FACP  Senior Associate Dean for Undergraduate Medical Education, Associate Professor of Medicine, University of Miami Miller School of Medicine

Alex J Mechaber, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Society of General Internal Medicine

Disclosure: Nothing to disclose.

Chief Editor

Julian Katz, MD  Clinical Professor of Medicine, Drexel University College of Medicine

Julian Katz, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Geriatrics Society, American Medical Association, American Society for Gastrointestinal Endoscopy, American Society of Law, Medicine & Ethics, American Trauma Society, Association of American Medical Colleges, and Physicians for Social Responsibility

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous coauthors, Ahmed Sherif, MD, Norvin Perez, MD, and David Greenwald, MD, to the development and writing of this article.

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