Diverticulitis Guidelines

Updated: Aug 06, 2019
  • Author: Elie M Ghoulam, MD, MS; Chief Editor: BS Anand, MD  more...
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Guidelines

Medical Society Guidelines

2015 American Gastroenterological Association (AGA) guidelines

The AGA recommendations on the treatment of diverticulitis include the following [5] :

  • Antibiotics should be used selectively in uncomplicated diverticulitis.

  • Colonoscopy should be performed after resolution of acute diverticulitis if a high-quality examination has not been done recently.

  • Prophylactic colonic resection in uncomplicated diverticulitis should be done on a case-by-case basis.

  • A fiber-rich diet or fiber supplementation as well as physical activity (ideally, daily rigorous exercise) are recommended after resolution.

  • Aspirin use can be continued after resolution, particularly if it is being used for secondary prevention.

  • It is not necessary to avoid nuts and popcorn in patients with diverticulosis or diverticulitis.

  • Avoid nonaspirin, nonsteroidal anti-inflammatory drugs if possible.

  • Mesalamine, rifaximin, and probiotics are not recommended to prevent recurrence.

2006 American Society of Colon and Rectal Surgeons (ASCRS) practice parameters

The ASCRS recommendations on the management of diverticulitis include the following [44] :

  • The initial evaluation should include a history and physical examination, complete blood cell count, urinalysis, and abdominal imaging in select cases.

  • Computed tomography (CT) scanning of the abdomen and pelvis is the most appropriate initial imaging method.

  • Ultrasonography and magnetic resonance imaging (MRI) can be useful imaging alternatives.

  • Nonsurgical treatment includes oral or intravenous antibiotics and diet modification.

  • Image-guided percutaneous drainage is usually the most appropriate treatment for stable patients with large diverticular abscesses.

  • After resolution of the incident diverticulitis, colonoscopy should be performed if it has not been done recently.

  • The decision regarding elective sigmoid colectomy should be individualized.

  • Elective colectomy should be considered after recovery from complicated diverticulitis.

  • Routine elective resection based on young age (< 50 years) is not recommended.

  • Urgent sigmoid colectomy is required for diffuse peritonitis or when nonsurgical management fails.

  • The decision to restore bowel continuity after resection must incorporate patient factors, intraoperative factors, and surgeon preference.