Diverticulitis Questions & Answers

1. [Guideline] Murphy T, Hunt RH, Fried M, Krabshuis JH. WGO Practice Guidelines. Diverticular disease. World Gastroenterology Organisation (WGO). Available at http://www.worldgastroenterology.org/diverticular-disease.html. 2007; Accessed: June 10, 2011.

2. Swanson SM, Strate LL. Acute colonic diverticulitis. Ann Intern Med. 2018 May 1. 168(9):ITC65-80. [QxMD MEDLINE Link]. [Full Text].

3. Wasvary H, Turfah F, Kadro O, Beauregard W. Same hospitalization resection for acute diverticulitis. Am Surg. 1999 Jul. 65(7):632-5; discussion 636. [QxMD MEDLINE Link].

4. Cuomo R, Cargiolli M, Cassarano S, Carabotti M, Annibale B. Treatment of diverticular disease, targeting symptoms or underlying mechanisms. Curr Opin Pharmacol. 2018 Oct 3. 43:124-31. [QxMD MEDLINE Link].

5. [Guideline] Stollman N, Smalley W, Hirano I, AGA Institute Clinical Guidelines Committee. American Gastroenterological Association Institute Guideline on the Management of Acute Diverticulitis. Gastroenterology. 2015 Dec. 149(7):1944-9. [QxMD MEDLINE Link]. [Full Text].

6. [Guideline] Solomkin JS, Mazuski JE, Bradley JS, et al. Diagnosis and management of complicated intra-abdominal infection in adults and children: guidelines by the Surgical Infection Society and the Infectious Diseases Society of America. Surg Infect (Larchmt). 2010 Feb. 11(1):79-109. [QxMD MEDLINE Link].

7. Gilbert DN, Chambers HF, Eliopoulos GM, et al. The Sanford Guide to Antimicrobial Therapy. 47th ed. Sperryville, VA: Antimicrobial Therapy, Inc; 2017.

8. [Guideline] Feingold D, Steele SR, Lee S, et al. Practice parameters for the treatment of sigmoid diverticulitis. Dis Colon Rectum. 2014 Mar. 57(3):284-94. [QxMD MEDLINE Link].

9. Regenbogen SE, Hardiman KM, Hendren S, Morris AM. Surgery for diverticulitis in the 21st century: a systematic review. JAMA Surg. 2014 Mar. 149(3):292-303. [QxMD MEDLINE Link]. [Full Text].

10. Hobson KG, Roberts PL. Etiology and pathophysiology of diverticular disease. Clin Colon Rectal Surg. 2004 Aug. 17(3):147-53. [QxMD MEDLINE Link]. [Full Text].

11. Matrana MR, Margolin DA. Epidemiology and pathophysiology of diverticular disease. Clin Colon Rectal Surg. 2009 Aug. 22(3):141-6. [QxMD MEDLINE Link]. [Full Text].

12. Hughes LE. Postmortem survey of diverticular disease of the colon. II. The muscular abnormality of the sigmoid colon. Gut. 1969 May. 10(5):344-51. [QxMD MEDLINE Link]. [Full Text].

13. Morson BC. The muscle abnormality in diverticular disease of the colon. Proc R Soc Med. 1963 Sep. 56:798-800. [QxMD MEDLINE Link]. [Full Text].

14. 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. [QxMD MEDLINE Link]. [Full Text].

15. [Guideline] Floch MH, Longo WE. United States guidelines for diverticulitis treatment. J Clin Gastroenterol. 2016 Oct. 50 suppl 1:S53-6. [QxMD MEDLINE Link].

16. Barbara G, Scaioli E, Barbaro MR, et al. Gut microbiota, metabolome and immune signatures in patients with uncomplicated diverticular disease. Gut. 2017 Jul. 66(7):1252-61. [QxMD MEDLINE Link].

17. Bharucha AE, Parthasarathy G, Ditah I, et al. Temporal trends in the incidence and natural history of diverticulitis: a population-based study. Am J Gastroenterol. 2015 Nov. 110(11):1589-96. [QxMD MEDLINE Link]. [Full Text].

18. 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. [QxMD MEDLINE Link]. [Full Text].

19. Sugihara K, Muto T, Morioka Y, Asano A, Yamamoto T. Diverticular disease of the colon in Japan. A review of 615 cases. Dis Colon Rectum. 1984 Aug. 27(8):531-7. [QxMD MEDLINE Link].

20. Elisei W, Brandimarte G, Tursi A. Management of diverticulosis: what's new?. Minerva Med. 2017 Oct. 108(5):448-63. [QxMD MEDLINE Link].

21. 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. [QxMD MEDLINE Link].

22. Brandl A, Kratzer T, Kafka-Ritsch R, et al. Diverticulitis in immunosuppressed patients: a fatal outcome requiring a new approach?. Can J Surg. 2016 Aug. 59(4):254-61. [QxMD MEDLINE Link]. [Full Text].

23. Peery AF. Recent advances in diverticular disease. Curr Gastroenterol Rep. 2016 Jul. 18(7):37. [QxMD MEDLINE Link].

24. Mueller MH, Glatzle J, Kasparek MS, 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. [QxMD MEDLINE Link].

25. Chapman J, Davies M, Wolff B, et al. Complicated diverticulitis: is it time to rethink the rules?. Ann Surg. 2005 Oct. 242(4):576-81; discussion 581-3. [QxMD MEDLINE Link]. [Full Text].

26. Strate LL, Liu YL, Aldoori WH, Syngal S, Giovannucci EL. Obesity increases the risks of diverticulitis and diverticular bleeding. Gastroenterology. 2009 Jan. 136 (1):115-22.e1. [QxMD MEDLINE Link]. [Full Text].

27. Jacobs DO. Clinical practice. Diverticulitis. N Engl J Med. 2007 Nov 15. 357(20):2057-66. [QxMD MEDLINE Link].

28. Siewert B, Tye G, Kruskal J, et al. Impact of CT-guided drainage in the treatment of diverticular abscesses: size matters. AJR Am J Roentgenol. 2006 Mar. 186(3):680-6. [QxMD MEDLINE Link]. [Full Text].

29. [Guideline] American College of Radiology. ACR appropriateness criteria: left lower quadrant pain - suspected diverticulitis. Available at https://acsearch.acr.org/docs/69356/Narrative/. 1996; reviewed 2014; Accessed: 2016.

30. Wilkins T, Embry K, George R. Diagnosis and management of acute diverticulitis. Am Fam Physician. 2013 May 1. 87(9):612-20. [QxMD MEDLINE Link]. [Full Text].

31. Boermeester MA, Humes DJ, Velmahos GC, Soreide K. Contemporary review of risk-stratified management in acute uncomplicated and complicated diverticulitis. World J Surg. 2016 Oct. 40(10):2537-45. [QxMD MEDLINE Link].

32. Gottlieb M, Shah N, Yu B. Can acute uncomplicated diverticulitis be safely treated without antibiotics?. Ann Emerg Med. 2019 Jun. 73(6):e75-e76. [QxMD MEDLINE Link].

33. Shabanzadeh DM, Wille-Jorgensen P. Antibiotics for uncomplicated diverticulitis. Cochrane Database Syst Rev. 2012 Nov 14. 11:CD009092. [QxMD MEDLINE Link].

34. 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. [QxMD MEDLINE Link].

35. Alonso S, Pera M, Pares D, et al. Outpatient treatment of patients with uncomplicated acute diverticulitis. Colorectal Dis. 2010 Oct. 12(10 online):e278-82. [QxMD MEDLINE Link].

36. 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. [QxMD MEDLINE Link].

37. Sirany AE, Gaertner WB, Madoff RD, Kwaan MR. Diverticulitis diagnosed in the emergency room: is it safe to discharge home?. J Am Coll Surg. 2017 Jul. 225(1):21-5. [QxMD MEDLINE Link].

38. Peery AF, Stollman N. Antibiotics for acute uncomplicated diverticulitis: time for a paradigm change?. Gastroenterology. 2015 Dec. 149(7):1650-1. [QxMD MEDLINE Link]. [Full Text].

39. Brochmann ND, Schultz JK, Jakobsen GS, Oresland T. Management of acute uncomplicated diverticulitis without antibiotics: a single-centre cohort study. Colorectal Dis. 2016 Nov. 18(11):1101-7. [QxMD MEDLINE Link].

40. US Food and Drug Administration. FDA Drug Safety Communication: Increased risk of death with Tygacil (tigecycline) compared to other antibiotics used to treat similar infections. Available at https://www.fda.gov/Drugs/DrugSafety/ucm224370.htm. September 1, 2010; Accessed: September 7, 2010.

41. US Food and Drug Administration. FDA Drug Safety Communication: FDA warns of increased risk of death with IV antibacterial Tygacil (tigecycline) and approves new Boxed Warning. Available at https://www.fda.gov/Drugs/DrugSafety/ucm369580.htm. September 27, 2013; Accessed: October 9, 2013.

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

43. Stollman N, Magowan S, Shanahan F, Quigley EM, DIVA Investigator Group. A randomized controlled study of mesalamine after acute diverticulitis: results of the DIVA trial. J Clin Gastroenterol. 2013 Aug. 47(7):621-9. [QxMD MEDLINE Link].

44. [Guideline] Rafferty J, Shellito P, Hyman NH, Buie WD, Standards Committee of American Society of Colon and Rectal Surgeons. Practice parameters for sigmoid diverticulitis. Dis Colon Rectum. 2006 Jul. 49(7):939-44. [QxMD MEDLINE Link].

45. 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. [QxMD MEDLINE Link].

46. 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. [QxMD MEDLINE Link].

47. Rink AD, John-Enzenauer K, Haaf F, Straub E, Nagelschmidt M, Vestweber KH. 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. [QxMD MEDLINE Link].

48. Cirocchi R, Nascimbeni R, Binda GA, et al. Surgical treatment of acute complicated diverticulitis in the elderly. Minerva Chir. 2018 Oct 9. 14(1):[QxMD MEDLINE Link].

49. 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. [QxMD MEDLINE Link]. [Full Text].

50. Shahedi K, Fuller G, Bolus R, et al. Progression from incidental diverticulosis to acute diverticulitis [abstract 847]. Gastroenterology. 2012 May. 142(5) suppl 1:S-144. [Full Text].

51. Lahat A, Avidan B, Sakhnini E, Katz L, Fidder HH, Meir SB. Acute diverticulitis: a decade of prospective follow-up. J Clin Gastroenterol. 2013 May-Jun. 47(5):415-9. [QxMD MEDLINE Link].

52. Deery SE, Hodin RA. Management of diverticulitis in 2017. J Gastrointest Surg. 2017 Oct. 21(10):1732-41. [QxMD MEDLINE Link]. [Full Text].

53. Ambrosetti P, Robert JH, Witzig JA, et al. Acute left colonic diverticulitis in young patients. J Am Coll Surg. 1994 Aug. 179(2):156-60. [QxMD MEDLINE Link].

54. 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. [QxMD MEDLINE Link].

55. Bordeianou L, Hodin R. Controversies in the surgical management of sigmoid diverticulitis. J Gastrointest Surg. 2007 Apr. 11(4):542-8. [QxMD MEDLINE Link]. [Full Text].

56. 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. [QxMD MEDLINE Link].

57. 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. [QxMD MEDLINE Link]. [Full Text].

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

59. Evans JP, Cooper J, Roediger WE. Diverticular colitis - therapeutic and aetiological considerations. Colorectal Dis. 2002 May. 4(3):208-12. [QxMD MEDLINE Link].

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

61. Floch MH, White JA. Management of diverticular disease is changing. World J Gastroenterol. 2006 May 28. 12(20):3225-8. [QxMD MEDLINE Link]. [Full Text].

62. Freeman SR. Diverticulitis. In: McNally PR, ed. GI/Liver Secrets. Philadelphia, PA: Hanley & Belfus; 1996. 332-8.

63. Hackethal V. Diverticulitis surgery often avoidable, new standard needed. January 16, 2014. Medscape Medical News. Available at http://www.medscape.com/viewarticle/819310. Accessed: January 20, 2014.

64. Isselbacher KJ, Epstein A. Diverticular disease. In: Fauci E, Braunwald E, Isselbacher KJ, et al, eds. Harrison's Principles of Internal Medicine. 14th ed. New York, NY: McGraw-Hill; 1998. 1648-9.

65. Janes SE, Meagher A, Frizelle FA. Management of diverticulitis. BMJ. 2006 Feb 4. 332(7536):271-5. [QxMD MEDLINE Link]. [Full Text].

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

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

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

69. 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. [QxMD MEDLINE Link].

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

71. [Guideline] Oliver G, Lowry A, Vernava A, 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. [QxMD MEDLINE Link].

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

73. Patel DG, Thomson WG. Diverticulitis and diverticular hemorrhage. In: Brandt LJ, ed. Clinical Practice of Gastroenterology. Philadelphia, PA: Churchill Livingstone; 1999. Vol 1: 727-32.

74. Pemberton JH, Armstrong DN, Dietzen CD. Diverticulitis. In: Yamada T, Alpers DH, Owyang C, et al, eds. Textbook of Gastroenterology. 2nd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 1995. 1876-88.

75. Poletti PA, Platon A, Rutschmann O, et al. Acute left colonic diverticulitis: can CT findings be used to predict recurrence?. AJR Am J Roentgenol. 2004 May. 182(5):1159-65. [QxMD MEDLINE Link]. [Full Text].

76. [Guideline] Rafferty J, Shellito P, Hyman NH, Buie WD, Standards Committee of American Society of Colon and Rectal Surgeons. Practice parameters for sigmoid diverticulitis. Dis Colon Rectum. 2006 Jul. 49(7):939-44. [QxMD MEDLINE Link].

77. Rampton DS. Diverticular colitis: diagnosis and management. Colorectal Dis. 2001 May. 3(3):149-53. [QxMD MEDLINE Link].

78. Rao PM, Rhea JT, Novelline RA, 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. [QxMD MEDLINE Link]. [Full Text].

79. Rege RV, Nahrwold DL. Diverticular disease. Curr Probl Surg. 1989 Mar. 26(3):133-89. [QxMD MEDLINE Link].

80. Regenbogen SE, Hardiman KM, Hendren S, Morris AM. Surgery for diverticulitis in the 21st century: a systematic review. JAMA Surg. 2014 Mar. 149(3):292-303. [QxMD MEDLINE Link].

81. 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. [QxMD MEDLINE Link].

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

83. Schreyer AG, Furst A, Agha A, 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. [QxMD MEDLINE Link].

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

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

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

87. 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. [QxMD MEDLINE Link].

88. 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. [QxMD MEDLINE Link].

89. 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. [QxMD MEDLINE Link].

90. Weizman AV, Nguyen GC. Diverticular disease: epidemiology and management. Can J Gastroenterol. 2011 Jul. 25(7):385-9. [QxMD MEDLINE Link]. [Full Text].

91. Wheat CL, Strate LL. Trends in hospitalization for diverticulitis and diverticular bleeding in the United States from 2000 to 2010. Clin Gastroenterol Hepatol. 2016 Jan. 14(1):96-103.e1. [QxMD MEDLINE Link]. [Full Text].

92. Carabotti M, Annibale B. Mesalamine (5-ASA) for the prevention of recurrent diverticulitis (Review). Tech Coloproctol. 2019 Jun. 23(6):597-9. [QxMD MEDLINE Link]. [Full Text].

93. Halim H, Askari A, Nunn R, Hollingshead J. Primary resection anastomosis versus Hartmann's procedure in Hinchey III and IV diverticulitis. World J Emerg Surg. 2019. 14:32. [QxMD MEDLINE Link]. [Full Text].

Elie M Ghoulam, MD, MS Resident Physician, Department of Internal Medicine, St Louis University School of Medicine

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Danisa M Clarrett, MD, MS Fellow, Division of Gastroenterology and Hepatology, St Louis University School of Medicine

Danisa M Clarrett, MD, MS is a member of the following medical societies: American College of Gastroenterology, American Medical Association, Student National Medical Association

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Elizabeth V Marsicano, MD Assistant Professor of Internal Medicine, Associate Program Director of Gastroenterology, Director of Clinical Operations, Division of Gastroenterology and Hepatology, St Louis University School of Medicine

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Marc D Basson, MD, PhD, MBA, FACS Senior Associate Dean for Medicine and Research, Professor of Surgery, Pathology, and Biomedical Sciences, University of North Dakota School of Medicine and Health Sciences

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

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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

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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

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

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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

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