Diverticulitis is inflammation or infection of small pouches (diverticula) that bulge out from the wall of the colon, most often on the left side. Many mild cases settle with rest and diet, while complications such as abscess or perforation need hospital care.
Key symptoms
- Steady pain in the left lower belly
- Fever and chills
- Nausea, loss of appetite
- Change in bowel habits, constipation or diarrhea
What you find on exam
- Tenderness in the left lower quadrant
- Fever and fast heart rate
- Guarding or rebound suggesting peritonitis
- Palpable tender mass if an abscess has formed
Tests
- Blood count and CRP
- CT of the abdomen and pelvis with contrast to confirm and find complications
- Urinalysis and pregnancy test when relevant
- Colonoscopy 6 to 8 weeks after recovery if not recently done
Treatment basics
- Mild uncomplicated cases: rest, clear liquids, and antibiotics only for selected patients
- Oral antibiotics such as amoxicillin-clavulanate when needed
- Hospital care with IV antibiotics for complicated cases or if unable to eat
- Drainage of an abscess or surgery for perforation
Red flags
- Severe diffuse belly pain with a rigid abdomen
- Low blood pressure or signs of sepsis
- Unable to keep fluids down or no improvement in 2 to 3 days
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.