Medscape is available in 5 Language Editions – Choose your Edition here.


Diverticulitis Treatment & Management

  • Author: Kamyar Shahedi, MD; Chief Editor: BS Anand, MD  more...
Updated: Jun 17, 2016

Approach Considerations

A surgical consultation as well as a gastroenterology consultation may be helpful.

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 3 episodes of uncomplicated diverticulitis to prevent further attacks is generally recommended by consensus guidelines. 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.


Medical Care

The approach to the treatment of diverticulitis can be broadly classified into either uncomplicated disease or complicated disease, with a few other special considerations to take into account. Acute uncomplicated diverticulitis is successfully treated in 70-100% of patients with conservative management.[11, 12, 13]

Acute diverticulitis tends to be more severe in very elderly people and in patients who are immunocompromised or who have debilitating comorbid conditions, such as diabetes and renal failure.

Patients with mild diverticulitis, typically with Hinchey stage I disease, can be started on an outpatient treatment regimen. This consists of a clear liquid diet and 7-10 days of oral broad-spectrum antimicrobial therapy, which covers anaerobic microorganisms, such as Bacteroides fragilis and Peptostreptococcus and Clostridium organisms , as well as aerobic microorganisms, such as Escherichia coli and Klebsiella, Proteus, Streptococcus, and Enterobacter organisms. Single and multiple antibiotic regimens are equally effective as long as both groups of organisms are covered. According to the World Gastroenterology Organisation (WGO) 2007 practice guidelines for diverticular disease, such a regimen should result in improvement within 48-72 hours.[1]  Note the following:

  • One typical oral antibiotic regimen is a combination of ciprofloxacin (or trimethoprim-sulfamethoxazole) and metronidazole. Moxifloxacin is appropriate monotherapy for outpatient treatment of uncomplicated diverticulitis. Amoxicillin/clavulanic acid monotherapy is acceptable as well.
  • Patients should be instructed to be on a clear liquid diet only and can advance the diet slowly as tolerated after clinical improvement, which usually occurs within 2-3 days.

Hospitalization is required with evidence of severe diverticulitis, such as systemic signs of infection or peritonitis. Patients who are unable to tolerate oral hydration, who fail outpatient therapy (ie, persistent or increasing fever, pain, or leukocytosis after 2-3 d), who are immunocompromised, or who have comorbidities may also require hospitalization. Pain may be severe enough to require parenteral narcotic analgesia. Consider the following:

  • Initiate bowel rest and intravenous fluid hydration. Start broad-spectrum intravenous antibiotic coverage until culture results, if obtained, are available.
  • Monotherapy with beta-lactamase inhibiting antibiotics or carbapenems provides broad antibacterial coverage and is appropriate for patients who are moderately ill and require admission. Such antibiotics include the following: piperacillin/tazobactam, ampicillin/sulbactam, ticarcillin/clavulanic acid, imipenem, or meropenem.
  • Multiple drug regimens are also appropriate options in the hospital setting and may consist of metronidazole and a third-generation cephalosporin or a fluoroquinolone. Such antibiotics include the following: ceftriaxone, cefotaxime, ceftolozane/tazobactam, ciprofloxacin, or levofloxacin. Previously, gentamicin was recommended as part of a multiple drug regimen. Although it is still a reasonable choice, substitution with a third-generation cephalosporin or a fluoroquinolone has been advocated to avoid the risk of aminoglycoside nephrotoxicity.
  • When severe penicillin allergy is a concern, tigecycline is a good choice for monotherapy.
  • For patients who are immunocompromised, imipenem or meropenem may be preferred over ertapenem for better enterococcal and pseudomonal coverage.
  • Pain management is important. Morphine is acceptable for pain control and is preferable over meperidine given the adverse effects associated with meperidine. Although early recommendations for pain management favored meperidine based on a theoretical risk of affecting bowel tone and sphincters, randomized prospective studies comparing the narcotic options are not available. Use of nonsteroidal anti-inflammatory drugs and corticosteroids have been associated with a greater risk of colon perforation and should be avoided whenever possible.
  • Within 2-3 days of hospitalization, the patient's fever, pain, and leukocytosis should begin to resolve. The patient can then be started on a clear liquid diet and advanced as tolerated. If tolerating oral intake and clinically stable, the patient can be discharged to complete a 7- to 10-day course of oral antibiotic therapy.
  • If fever and leukocytosis do not resolve after 2-3 days of treatment or if serial examinations reveal worsening signs or new peritoneal findings, a repeat CT scan of the abdomen is advisable to rule out an abdominal abscess or other complications. The WGO 2007 guidelines state that a lack of improvement should prompt clinical suspicion and an investigation for a phlegmon or an abscess. [1]
  • If a patient is found to have a peridiverticular abscess that measures more than 4 cm in diameter (Hinchey stage II disease), a CT–guided percutaneous drainage is indicated. This usually leads to a prompt (< 72 h) reduction in pain, fever, and leukocytosis. Percutaneous drainage is also beneficial in that it may allow for elective surgery rather than emergency surgery and increase the likelihood of a successful 1-stage procedure.
  • For abscess cavities containing gross fecal material or when there is perforation, early surgical intervention is required.

Once the acute episode has resolved, the patient may advance diet as tolerated and then maintain a lifelong high-fiber diet. Colonoscopy or, alternatively, barium enema with flexible sigmoidoscopy should be done after resolution of an initial episode (typically 2-6 wk after recovery) to exclude other diagnoses, such as cancer, ischemia, and inflammatory bowel disease.

An increasing number of studies have reported the efficacy of different regimens of anti-inflammatory agents, including mesalamine, nonabsorbable antibiotics such as rifaximin, and probiotics alone or in combination in the management of diverticulitis.[14, 15]

In the first US double-blind, placebo-controlled trial of the anti-inflammatory agent mesalamine for diverticulitis, 117 patients were randomly assigned within 7 days of documented acute diverticulitis to a once-daily regimen of either 2.4 g delayed-release mesalamine or placebo over 12 weeks, followed by a 9-month treatment-free period. Global symptoms scores for 10 gastrointestinal symptoms on a 0-6 Likert scale were persistently lower in patients receiving mesalamine compared with the placebo group. The rate of complete response was significantly higher with mesalamine than placebo at 6 weeks and 52 weeks, while probiotics in combination with mesalamine did not provide additional efficacy.[15]

Dietary and activity considerations

In mild episodes, a clear liquid diet is advised. Clinical improvement should occur within 2-3 days, and the diet can then be advanced as tolerated.

Administer nothing by mouth in episodes of moderate-to-severe acute diverticulitis.

Studies imply a high-fiber diet will prevent progression of diverticulosis. However, after patients have become symptomatic, the benefit of fiber supplementation is less clear. Recommending to patients to avoid seeds and nuts is currently less common, since it is now thought that seeds and nuts may not play a significant role in the development of diverticulitis, as believed in the past.

Long-term management probably includes a high-fiber, low-fat diet.

Normal activity is possible after resolution of the acute episode. 


Surgical Care

About 15-25% of patients presenting with a first episode of acute diverticulitis have complicated disease that requires surgery. According to the WGO 2007 guidelines, 15-30% of patients admitted for the management of diverticulitis will need surgery during their admission, with an 18% surgical mortality rate.[1]

The classic surgical indications include some features characteristic of Hinchey stage III or IV disease and are as follows:

  • Free-air perforation with fecal peritonitis
  • Suppurative peritonitis secondary to a ruptured abscess
  • Uncontrolled sepsis
  • Abdominal or pelvic abscess (unless CT-guided aspiration is possible)
  • Fistula formation
  • Inability to rule out carcinoma
  • Intestinal obstruction
  • Failing medical therapy
  • Immunocompromised status
  • Extremes of age

Recurrent episodes of acute diverticulitis: Elective surgery was previously recommended in any patient who had 2 or more episodes of diverticulitis that were successfully treated medically; data have since called this practice into question when the patient is otherwise healthy.

Preoperative preparation with antibiotics should be given in all patients. Single and multiple drug regimens, as discussed in Medical Care, are appropriate choices. However, for patients with more extensive contamination, a single drug regimen (with either imipenem/cilastin or piperacillin/tazobactam) or a multiple drug regimen (with ampicillin, gentamicin, and metronidazole) may be warranted for peritonitis. Bowel preparation is usually possible for nonemergent situations.

Guidelines from the American Society of Colon and Rectal Surgeons (2006) recommend emergency surgery for patients with diffuse peritonitis and for those who fail nonoperative management. Also, patients who are immunosuppressed or immunocompromised are at an increased risk of failing medical therapy or bowel perforation and should be approached with a lower threshold for surgery.[16]

A 2-stage surgical approach is the most common surgical procedure performed today for the emergency treatment of acute diverticulitis. Note the following

  • A traditional Hartmann procedure is commonly performed, which involves resection of the diseased segment of bowel, an end-colostomy, and closure of the rectal stump. Typically, 3 months later, a second procedure can be performed in which the colostomy is reversed and intestinal continuity is reestablished with the rectal stump; however, this second operation can be technically difficult and is not performed in many patients. This is the preferred approach in patients with fecal peritonitis and in most cases of purulent peritonitis. [17, 18]
  • An alternative to the Hartmann procedure involves resection of the diseased colon, primary anastomosis (with or without intraoperative colonic lavage), and proximal diverting stoma, either colostomy or ileostomy. The second procedure in this course would be to close the stoma. This approach is primarily used when there are relative contraindications to primary anastomosis but no purulent or feculent peritonitis and there is nonedematous bowel. The advantage is that it avoids the technically difficult second stage used in the Hartmann procedure.
  • Extensive and unnecessary dissections, which open up tissue planes to infection and increase blood loss, have no role.
  • Examining data from patients who had undergone the Hartmann procedure for acute diverticulitis and then (after a median 7-month period) had undergone reversal surgery, Fleming and Gillen investigated the rate of and risk factors for complications linked to the reversal procedure. [18] The authors found that out of 76 reversal patients, 18 of them (25%) had post-reversal complications.
  • Fleming and Gillen also found in the above study that risk factors for reversal complications included being a current smoker, having a low preoperative albumin level, and allowing a prolonged period of time to pass between the Hartmann and reversal procedures. The authors concluded that despite the reversal surgery's significant complication rate, offering the operation to appropriately selected patients is acceptable. They also suggested that preoperative identification of modifiable risk factors may benefit patients.

The decision to proceed with elective surgery, typically at least 6 weeks after recovery from acute diverticulitis, should be made on a case-by-case basis. As recommended by the 2007 WGO guidelines, this decision should consider age and medical condition of the patient, frequency and severity of attacks, and the presence of any persistent symptoms after the acute episode. Other appropriate indications for elective colectomy include inability to exclude carcinoma, following an episode of complicated diverticulitis treated nonoperatively, or after percutaneous drainage of a diverticular abscess.[1]  Note the following:

  • Regarding frequency, after one attack, about one third of patients will have a second attack of acute diverticulitis. After a second episode, a further one third will have yet another attack. According to the 2007 WGO guidelines, a repeat episode requires immediate surgery if complications occur, such as free perforation, obstruction, abscess that is not resolved by percutaneous drainage, fistulas, and failure to respond to treatment. [1]
  • Regarding severity, most patients who present with complicated diverticulitis do so at the time of their first episode. Therefore, once a patient's initial presentation has been determined to be uncomplicated or complicated, the patient's future episodes are likely to follow a similar course.
  • A 1-stage surgical approach with resection and primary anastomosis is often possible in elective settings since the disease is well localized and/or significantly resolved. The bowel must be well vascularized, nonedematous, tension free, and well prepared. The proximal margin should be an area of pliable colon without hypertrophy or inflammation. The distal margin should extend to the upper third of the rectum where the taenia coalesces. Not all of the diverticula-bearing colon needs to be removed, since diverticula proximal to the descending or sigmoid colon are unlikely to result in further symptoms.
  • Patients with Hinchey stage I or II disease can usually have preoperative bowel preparation.

The classic 3-stage surgical approach is now rarely indicated because of high associated morbidity and mortality and is considered only in critical situations in which resection cannot safely be performed. Consider the following:

  • In this approach, the initial operation is simply drainage of the diseased segment and creation of a proximal diversion colostomy, without resection.
  • The second operation is performed 2-8 weeks later to resect the diseased bowel and perform a primary anastomosis.
  • A third operation, performed 2-4 weeks after the second operation, closes the stoma.
  • Increasing experience with laparoscopic techniques for colon resection suggests that some of its advantages include less pain, a smaller scar, and shorter recovery time. [19] There is no change in early or late complications, and the cost and outcome are comparable to open procedures. The laparoscopic approach is best suited for patients in whom the episode of acute diverticulitis has resolved and in patients with Hinchey stage I or II disease.

Special considerations exist for some forms of complicated diverticulitis, such as the following:

  • For diffuse peritonitis, an appropriate initial empiric antibiotic regimen must include either single agent therapy with imipenem/cilastin or piperacillin/tazobactam or multiple drug therapy with ampicillin, gentamicin, and metronidazole.
  • Obstruction needs to be differentiated from carcinoma, and, even if biopsy results are negative, resection may be necessary to exclude carcinoma if there is enough suspicion based upon appearance alone.
  • Abscesses without peritonitis may be amenable to percutaneous drainage with an elective single-stage operation after the episode has resolved. Drainage is usually through the anterior abdominal wall but may be done transgluteally or through the rectum or the vagina, depending on the location of the abscess. Catheter drainage may be helpful in patients who cannot undergo surgery and should be left in place until drainage is less than 10 mL in 24 hours. Catheter sinograms can be performed periodically to monitor the resolution of the abscess cavity before the catheter is removed.
  • Fistulas generally do not close spontaneously, but they may be managed with an elective 1-stage procedure in most cases. Also, in the absence of urinary tract obstruction, observation appears safe in patients with contraindications to surgery.
  • Patients who are immunosuppressed are at an increased risk of perforation, and surgery is necessary in almost all patients who are either already immunosuppressed or are about to start immunosuppressive therapy.






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.[20]


Long-Term Monitoring

After recovering from acute diverticulitis, patients should have their colons examined to rule out malignancy. Current modalities include colonoscopy, barium enema, and CT colonography (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. Although the technology is now widely available in many centers, it is limited by the inability to sample suspicious lesions.

Contributor Information and Disclosures

Kamyar Shahedi, MD Clinical Instructor, Olive View-UCLA Medical Center, University of California, Los Angeles, David Geffen School of Medicine

Kamyar Shahedi, MD is a member of the following medical societies: American College of Physicians, American Medical Association, California 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, Southern California Society of Gastroenterology

Disclosure: Nothing to disclose.

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, American Medical Association

Disclosure: Nothing to disclose.

Duminda B Suraweera, MD Resident Physician, Department of Medicine, Olive View–UCLA Medical Center

Duminda B Suraweera, MD is a member of the following medical societies: American College of Physicians

Disclosure: Nothing to disclose.

Specialty Editor Board

Marc D Basson, MD, PhD, MBA, FACS Associate Dean for Medicine, Professor of Surgery and Basic Science, University of North Dakota School of Medicine and Health Sciences

Marc D Basson, MD, PhD, MBA, FACS is a member of the following medical societies: Alpha Omega Alpha, American College of Surgeons, American Gastroenterological Association, Phi Beta Kappa, Sigma Xi

Disclosure: Nothing to disclose.

Chief Editor

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, American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.


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.

David Greenwald, MD Associate Professor of Clinical Medicine, Fellowship Program Director, Department of Medicine, Division of Gastroenterology, Montefiore Medical Center, Albert Einstein College of Medicine

David Greenwald, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy, and New York Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Norvin Perez, MD Medical Director, Juneau Urgent and Family Care

Norvin Perez, MD is a member of the following medical societies: American College of Emergency Physicians and American Medical Association

Disclosure: Nothing to disclose.

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.

Ahmed Sherif, MD Staff Physician, Department of Internal Medicine, Montefiore Medical Center

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

  1. [Guideline] World Gastroenterology Organisation (WGO). Practice Guidelines 2007. Diverticular disease. Available at Accessed: 10 June 2011.

  2. Karatepe O, Gulcicek OB, Adas G, et al. Cecal diverticulitis mimicking acute appendicitis: a report of 4 cases. World J Emerg Surg. 2008 Apr 21. 3:16. [Medline]. [Full Text].

  3. Shahedi K, Fuller G, Bolus R, et al. Long-term risk of acute diverticulitis among patients with incidental diverticulosis found during colonoscopy. Clin Gastroenterol Hepatol. 2013 Dec. 11(12):1609-13. [Medline].

  4. Shahedi K, Fuller G, Bolus R, et al. Progression from Incidental Diverticulosis to Acute Diverticulitis. Gastroenterol. 2012 May. 142(5) Suppl 1:S-144. [Full Text].

  5. Strate LL, Modi R, Cohen E, Spiegel BM. Diverticular disease as a chronic illness: evolving epidemiologic and clinical insights. Am J Gastroenterol. 2012 Oct. 107(10):1486-93. [Medline].

  6. Lahat A, Avidan B, Sakhnini E, Katz L, Fidder HH, Meir SB. Acute Diverticulitis: A Decade of Prospective Follow-up. J Clin Gastroenterol. 2013 Jan 16. [Medline].

  7. Brandl A, Kratzer T, Kafka-Ritsch R, et al. Diverticulitis in immunosuppressed patients: A fatal outcome requiring a new approach?. Can J Surg. 2016 Jun 1. 59 (4):12915. [Medline].

  8. Peery AF. Recent advances in diverticular disease. Curr Gastroenterol Rep. 2016 Jul. 18 (7):37. [Medline].

  9. Strate LL, Liu YL, Aldoori WH, Syngal S, Giovannucci EL. Obesity increases the risks of diverticulitis and diverticular bleeding. Gastroenterology. 2009 Jan. 136(1):115-122.e1. [Medline]. [Full Text].

  10. [Guideline] Miller FH, Bree RL, Rosen MP, et al. Expert Panel on Gastrointestinal Imaging. ACR Appropriateness Criteria left lower quadrant pain. [online publication]. Reston (VA): American College of Radiology (ACR); 2008. [Full Text].

  11. Ricciardi R, Baxter NN, Read TE, Marcello PW, Hall J, Roberts PL. Is the decline in the surgical treatment for diverticulitis associated with an increase in complicated diverticulitis?. Dis Colon Rectum. 2009 Sep. 52(9):1558-63. [Medline].

  12. Alonso S, Pera M, Pares D, et al. Outpatient treatment of patients with uncomplicated acute diverticulitis. Colorectal Dis. 2009 Nov 10. [Medline].

  13. Sanchez-Velazquez P, Grande L, Pera M. Outpatient treatment of uncomplicated diverticulitis: a systematic review. Eur J Gastroenterol Hepatol. 2016 Jun. 28 (6):622-7. [Medline].

  14. Trivedi CD, Das KM. Emerging therapies for diverticular disease of the colon. J Clin Gastroenterol. 2008 Nov-Dec. 42(10):1145-51. [Medline].

  15. Stollman N, Magowan S, Shanahan F, Quigley EM. A Randomized Controlled Study of Mesalamine After Acute Diverticulitis: Results of the DIVA Trial. J Clin Gastroenterol. 2013 Feb 18. [Medline].

  16. [Guideline] Rafferty J, Shellito P, Hyman NH, Buie WD. Practice parameters for sigmoid diverticulitis. Dis Colon Rectum. 2006 Jul. 49(7):939-44. [Medline]. [Full Text].

  17. Riansuwan W, Hull TL, Millan MM, Hammel JP. Nonreversal of Hartmann's procedure for diverticulitis: derivation of a scoring system to predict nonreversal. Dis Colon Rectum. 2009 Aug. 52(8):1400-8. [Medline].

  18. Fleming FJ, Gillen P. Reversal of Hartmann's procedure following acute diverticulitis: is timing everything?. Int J Colorectal Dis. 2009 Oct. 24(10):1219-25. [Medline].

  19. Rink AD, John-Enzenauer K, Haaf F, et al. Laparoscopic-assisted or laparoscopic-facilitated sigmoidectomy for diverticular disease? A prospective randomized trial on postoperative pain and analgesic consumption. Dis Colon Rectum. 2009 Oct. 52(10):1738-45. [Medline].

  20. Crowe FL, Appleby PN, Allen NE, Key TJ. Diet and risk of diverticular disease in Oxford cohort of European Prospective Investigation into Cancer and Nutrition (EPIC): prospective study of British vegetarians and non-vegetarians. BMJ. 2011 Jul 19. 343:d4131. [Medline]. [Full Text].

  21. Ambrosetti P, Robert JH, Witzig JA, Mirescu D, Mathey P, Borst F, et al. Acute left colonic diverticulitis in young patients. J Am Coll Surg. 1994 Aug. 179(2):156-60. [Medline].

  22. Bahadursingh AM, Virgo KS, Kaminski DL, Longo WE. Spectrum of disease and outcome of complicated diverticular disease. Am J Surg. 2003 Dec. 186(6):696-701. [Medline].

  23. Bordeianou L, Hodin R. Controversies in the surgical management of sigmoid diverticulitis. J Gastrointest Surg. 2007 Apr. 11(4):542-8. [Medline].

  24. Broderick-Villa G, Burchette RJ, Collins JC, Abbas MA, Haigh PI. Hospitalization for acute diverticulitis does not mandate routine elective colectomy. Arch Surg. 2005 Jun. 140(6):576-81; discussion 581-3. [Medline].

  25. Caterino JM, Emond JA, Camargo CA Jr. Inappropriate medication administration to the acutely ill elderly: a nationwide emergency department study, 1992-2000. J Am Geriatr Soc. 2004 Nov. 52(11):1847-55. [Medline].

  26. Chapman J, Davies M, Wolff B, Dozois E, Tessier D, Harrington J, et al. Complicated diverticulitis: is it time to rethink the rules?. Ann Surg. 2005 Oct. 242(4):576-81; discussion 581-3. [Medline].

  27. Dominguez EP, Sweeney JF, Choi YU. Diagnosis and management of diverticulitis and appendicitis. Gastroenterol Clin North Am. 2006 Jun. 35(2):367-91. [Medline].

  28. Evans JP, Cooper J, Roediger WE. Diverticular colitis - therapeutic and aetiological considerations. Colorectal Dis. 2002 May. 4(3):208-212. [Medline].

  29. Ferzoco LB, Raptopoulos V, Silen W. Acute diverticulitis. N Engl J Med. 1998 May 21. 338(21):1521-6. [Medline].

  30. Floch MH, White JA. Management of diverticular disease is changing. World J Gastroenterol. 2006 May 28. 12(20):3225-8. [Medline].

  31. Freeman SR. Diverticulitis. McNally PR, ed. GI/Liver Secrets. Philadelphia, Pa: Hanley & Belfus; 1996. 332-338.

  32. Hackethal V. Diverticulitis Surgery Often Avoidable, New Standard Needed. Medscape [serial online]. Available at Accessed: January 20, 2014.

  33. Isselbacher KJ, Epstein A. Diverticular disease. Braunwald E, Longo DL, et al, eds. Harrison's Principles of Internal Medicine. 14th ed. McGraw-Hill; 1998. 1648-1649.

  34. Jacobs DO. Clinical practice. Diverticulitis. N Engl J Med. 2007 Nov 15. 357(20):2057-66. [Medline].

  35. Janes SE, Meagher A, Frizelle FA. Management of diverticulitis. BMJ. 2006 Feb 4. 332(7536):271-5. [Medline].

  36. Kazzi AA. Diverticular disease. Medscape Reference. 2006. [Full Text].

  37. Kornitzer BS, Manace LC, Fischberg DJ, Leipzig RM. Prevalence of meperidine use in older surgical patients. Arch Surg. 2006 Jan. 141(1):76-81. [Medline].

  38. Marinella MA, Mustafa M. Acute diverticulitis in patients 40 years of age and younger. Am J Emerg Med. 2000 Mar. 18(2):140-2. [Medline].

  39. McCarthy DW, Bumpers HL, Hoover EL. Etiology of diverticular disease with classic illustrations. J Natl Med Assoc. 1996 Jun. 88(6):389-90. [Medline]. [Full Text].

  40. Miura S, Kodaira S, Shatari T, Nishioka M, Hosoda Y, Hisa TK. Recent trends in diverticulosis of the right colon in Japan: retrospective review in a regional hospital. Dis Colon Rectum. 2000 Oct. 43(10):1383-9. [Medline].

  41. Mueller MH, Glatzle J, Kasparek MS, Becker HD, Jehle EC, Zittel TT, et al. Long-term outcome of conservative treatment in patients with diverticulitis of the sigmoid colon. Eur J Gastroenterol Hepatol. 2005 Jun. 17(6):649-54. [Medline].

  42. Novak JS, Tobias J, Barkin JS. Nonsurgical management of acute jejunal diverticulitis: a review. Am J Gastroenterol. 1997 Oct. 92(10):1929-31. [Medline].

  43. Oliver G, Lowry A, Vernava A, Hicks T, Burnstein M, Denstman F, et al. Practice parameters for antibiotic prophylaxis--supporting documentation. The Standards Task Force. The American Society of Colon and Rectal Surgeons. Dis Colon Rectum. 2000 Sep. 43(9):1194-200. [Medline]. [Full Text].

  44. Parks TG. Natural history of diverticular disease of the colon. Clin Gastroenterol. 1975 Jan. 4(1):53-69. [Medline].

  45. Patel DG, Thomson WG. Diverticulitis and diverticular hemorrhage. Clinical Practice of Gastroenterology. Philadelphia, Pa: Churchill Livingstone; 1999. 727-732.

  46. Pemberton JH, Armstrong DN, Dietzen CD. Diverticulitis. Yamada T, Alpers DH, et al, eds. Textbook of Gastroenterology. Philadelphia, Pa: Lippincott Williams & Wilkins; 1995. 1876-1888.

  47. Poletti PA, Platon A, Rutschmann O, Kinkel K, Nyikus V, Ghiorghiu S, et al. Acute left colonic diverticulitis: can CT findings be used to predict recurrence?. AJR Am J Roentgenol. 2004 May. 182(5):1159-65. [Medline].

  48. Rafferty J, Shellito P, Hyman NH, Buie WD. Practice parameters for sigmoid diverticulitis. Dis Colon Rectum. 2006 Jul. 49(7):939-44. [Medline].

  49. Rampton DS. Diverticular colitis: diagnosis and management. Colorectal Dis. 2001 May. 3(3):149-53. [Medline].

  50. Rao PM, Rhea JT, Novelline RA, Dobbins JM, Lawrason JN, Sacknoff R, et al. Helical CT with only colonic contrast material for diagnosing diverticulitis: prospective evaluation of 150 patients. AJR Am J Roentgenol. 1998 Jun. 170(6):1445-9. [Medline].

  51. Rege RV, Nahrwold DL. Diverticular disease. Curr Probl Surg. 1989 Mar. 26(3):133-89. [Medline].

  52. Regenbogen SE, Hardiman KM, Hendren S, Morris AM. Surgery for Diverticulitis in the 21st Century: A Systematic Review. JAMA Surg. 2014 Jan 15. [Medline].

  53. Ripolles T, Agramunt M, Martinez MJ, Costa S, Gomez-Abril SA, Richart J. The role of ultrasound in the diagnosis, management and evolutive prognosis of acute left-sided colonic diverticulitis: a review of 208 patients. Eur Radiol. 2003 Dec. 13(12):2587-95. [Medline].

  54. Schoetz DJ Jr. Uncomplicated diverticulitis. Indications for surgery and surgical management. Surg Clin North Am. 1993 Oct. 73(5):965-74. [Medline].

  55. Schreyer AG, Furst A, Agha A, Kikinis R, Scheibl K, Scholmerich J, et al. Magnetic resonance imaging based colonography for diagnosis and assessment of diverticulosis and diverticulitis. Int J Colorectal Dis. 2004 Sep. 19(5):474-80. [Medline].

  56. Silverman ME, Shih RD, Allegra J. Morphine induces less nausea than meperidine when administered parenterally. J Emerg Med. 2004 Oct. 27(3):241-3. [Medline].

  57. Wu JS, Baker ME. Recognizing and managing acute diverticulitis for the internist. Cleve Clin J Med. 2005 Jul. 72(7):620-7. [Medline].

  58. Yacoe ME, Jeffrey RB Jr. Sonography of appendicitis and diverticulitis. Radiol Clin North Am. 1994 Sep. 32(5):899-912. [Medline].

  59. Harvey J, Roberts PL, Schoetz DJ, et al. Do appendicitis and diverticulitis share a common pathological link?. Dis Colon Rectum. 2016 Jul. 59 (7):656-61. [Medline].

  60. Wright GP, Flermoen SL, Robinett DM, Charney KN, Chung MH. Surgeon specialization impacts the management but not outcomes of acute complicated diverticulitis. Am J Surg. 2016 Jun. 211 (6):1035-40. [Medline].

  61. Mali JP, Mentula PJ, Leppäniemi AK, Sallinen VJ. Symptomatic treatment for uncomplicated acute diverticulitis: a prospective cohort study. Dis Colon Rectum. 2016 Jun. 59 (6):529-34. [Medline].

All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.