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By age 50, one third of adults have diverticulosis coli; two thirds have diverticulosis by age 80. Ten to 20% of patients with diverticulosis will have complications of diverticulitis or diverticular hemorrhage.

Causes of Diverticulosis. Aging, elevation of colonic intraluminal pressure, and decreased dietary fiber. Diverticula occur where nutrient arteries penetrate the muscularis propria.

Clinical Presentation of Diverticulitis

Diverticulitis is characterized by the abrupt onset of unremitting left-lower quadrant abdominal pain, fever, and an alteration in bowel pattern. Diverticulitis of the transverse colon may simulate ulcer pain; diverticulitis of the cecum and redundant sigmoid may resemble appendicitis.

Right sided diverticulosis is more common among Asians (>75%) than among Europeans. Frank rectal bleeding is usually not seen with diverticulitis.

Physical Exam. Left-lower quadrant tenderness is characteristic. Abdominal examination is often diverticulitis deceptively unremarkable in the elderly and in persons.

    Differential Diagnosis of Diverticulitis


    Middle Aged and Young

    Ischemic colitis



    Colonic diverticulitis Obstruction

    Penetrating diverticulitis ulcer




    Inflammatory bowel disease

    Penetrating ulcer


Diagnostic Evaluation

Plain X-rays may show ileus, obstruction, mass effect, ischemia, or perforation.

CT scan is the test of choice to evaluate acute diverticulitis. The CT scan can be used for staging the degree of complications and ruling out other diseases.

Contrast Enema. Water soluble contrast is safe and useful in mild-to-moderate cases of diverticulitis when the diagnosis is in doubt.

Endoscopy. Acute diverticulitis is a relative contraindication to endoscopy; perforation should be excluded first. Endoscopy is indicated when the diagnosis is in doubt to exclude the possibility of ischemic bowel, Crohn's disease, or carcinoma.

Ultrasound occasionally is helpful to evaluate acute diverticulitis, although intestinal gas often interferes with the exam.

Complete blood count may show leukocytosis


Outpatient Treatment

Clear liquid diet

Oral antibiotics

Ciprofloxacin (Cipro) 500 mg PO bid AND

Metronidazole (Flagyl) 500 mg PO qid.

Inpatient Treatment

Severe cases require hospitalization for gastrointestinal tract rest (NPO), intravenous fluid hydration, correction of electrolyte abnormalities, and antibiotics.