Diverticulitis

Diverticulitis is inflammation of diverticula and complicates 20% of cases of diverticulosis. Patients experience abdominal pain localized mainly to the left lower quadrant, fever chills, anorexia, palpable tender mass, leukocytosis, and rebound tenderness associated with peritoneal inflammation. Hallmarks on barium enema include distorted diverticlar sacs, evidence of abscess, and leakage of barium outside the bowel lumen. CT may show inflammation/stranding of the pericolonic fat, pericolonic abscess, focal bowel wall thickening, or diverticula near the site of inflammation. Complications include peritonitis, bleeding, bowel obstruction, and sinus tract, fistula, and abscess formation. About 2% of patients will require hospitalized care and 1% will need surgical intervention. Therapy consists of IV fluids, NG suction, and pain control. Surgery is indicated if there is excessive bleeding, perforation, recurrent disease, toxicity, unhealing abscesses or fistulae.