Priscilla Marsicovetere is Assistant Professor of Medical Education and Surgery, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, and Program Director for the Franklin Pierce University, PA Program, Lebanon, New Hampshire. She practices with Emergency Services of New England, Springfield Hospital, Springfield, Vermont.
The author has no financial relationships to disclose.
Treatment of this common complication of diverticular disease is predicated on whether the presentation signals uncomplicated or complicated disease. While some uncomplicated cases require hospitalization, many are amenable to primary care outpatient, and often conservative, management. The longstanding practice of antibiotic treatment of uncomplicated cases is now considered a selective, rather than a routine, option.
Diverticular disease is one of the most common conditions in the Western world and one of the most frequent indications for gastrointestinal-related hospitalization.1 It is among the 10 most common diagnoses in patients presenting to the clinic or emergency department with acute abdominal pain.2 Prevalence increases with age: Up to 60% of persons older than 60 are affected.3 The most common complication of diverticular disease is diverticulitis, which occurs in up to 25% of patients.4
The spectrum of clinical presentations of diverticular disease ranges from mild, uncomplicated disease that can be treated in the outpatient setting to complicated disease with sepsis and possible emergent surgical intervention. The traditional approach to diverticulitis has been management with antibiotics and likely sigmoid colectomy, but recent studies support a paradigm shift toward more conservative, nonsurgical treatment.
This article highlights current trends in diagnosis and management of acute diverticulitis.
DEFINITION AND EPIDEMIOLOGY
Diverticular disease is marked by sac-like outpouchings, called diverticula, that form at structurally weak points of the colon wall, predominantly in the descending and sigmoid colon.5 The prevalence of diverticular disease is increasing globally, affecting more than 10% of people older than 40, as many as 60% of those older than 60, and more than 70% of people older than 80.1,3 The mean age for hospital admission for acute diverticulitis is 63.3
Worldwide, males and females are affected equally.3 In Western society, the presence of diverticula, also called diverticulosis, is more often left-sided; right-sided disease is more prevalent in Asia.3,5
The most common complication of diverticular disease is diverticulitis—inflammation of a diverticulum—which affects 10% to 25% of patients with diverticular disease during their lifetime.4,5 Diverticulitis can be classified as uncomplicated(characterized by colonic wall thickening or pericolic inflammatory changes) or complicated(characterized by abscesses, fistulae, obstruction, or localized or free perforations).1,6 As many as 25% of diverticulitis cases are considered complicated.4,5 The severity of diverticulitis is commonly graded using the Hinchey Classification (Table 1).1,7
