Diverticulitis is a form of diverticular disease, which occurs when diverticula, small pouches in the wall of the large intestine (colon), push through weak spots in the colon’s outer muscle layers. Inflammation of these diverticula are called diverticulitis.
Treatment for diverticulitis depends on the severity, complications that may be present, and other underlying medical conditions.
An attack of uncomplicated, mild diverticulitis may go away on its own, but it is important to see a doctor to assess the severity and determine if treatment is needed.
To calm down a mild diverticulitis attack:
- Drink plenty of fluids
- If you have kidney, heart, or liver disease and need to limit fluids, talk to your doctor about fluid intake
- A clear liquid diet for two to three days
- Progress to a bland, soft diet as tolerated such as the BRAT diet:
- Bananas
- Rice (white)
- Applesauce
- Toast, plain or with only jelly or honey if desired
- Use a heating pad to relieve mild cramps and pain
- Acetaminophen (Tylenol) for pain
- Rest
- Do not use laxatives or enemas unless instructed to do so by your doctor
Other treatments for mild diverticulitis may include:
- 7-10 days of oral broad-spectrum antibiotics if needed, such as:
- Ciprofloxacin (Cipro) plus metronidazole (Flagyl)
- Trimethoprim-sulfamethoxazole (Bactrim) plus metronidazole (Flagyl)
- Amoxicillin-clavulanate (Augmentin)
- Moxifloxacin (Avelox) (for patients intolerant of both metronidazole and beta-lactam agents)
- Antispasmodics for pain
In more severe cases, hospitalization may be needed. If hospitalized, treatment may include:
- Clear liquid diet; progress to a soft diet as tolerated
- Intravenous (IV) or oral antibiotics
- Beta-lactamase-inhibiting antibiotics such as piperacillin/tazobactam (Tazocin) and ticarcillin/clavulanic acid (Timentin)
- Carbapenems such as ertapenem (Invanz)
- Abscesses less than 3 cm: Typically resolved with antibiotics
- Abscesses greater than 4 cm: Drain percutaneously
- Pain management
- Morphine is preferred, though it may affect bowel tone and sphincters
- Acetaminophen and antispasmodics such as dicyclomine are first-line medications used to manage pain and cramping in mild to moderate disease
- Elective surgical resection
What Are Symptoms of Diverticulitis?
Early symptoms of diverticulitis include:
- Abdominal pain (most commonly in the left lower quadrant)
- Nausea
- Vomiting
- Constipation (may be severe)
- Fever
- Gas (flatulence)
- Bloating
How Is Diverticulitis Diagnosed?
Diverticulitis is diagnosed based on a medical history and physical examination.
Laboratory tests that may be indicated include:
- Blood tests
- Blood cultures
- White blood cell count
- Electrolyte assays
- Hemoglobin level
- Renal function tests
- Liver enzyme and lipase levels
- Urine tests
- Urinalysis
- Urine culture
- Stool test for blood
- A pregnancy test for females of childbearing age with abdominal pain
Imaging tests may include:
From
http://emedicine.medscape.com/article/173388-overview