The Purple Book

Diverticulitis

Definition

• Inflammation or infection of diverticular pockets of the bowel

Cause

• probably initiated by blockages or obstruction about the diverticular pockets

Symptoms

• abdominal pain
• diarrhoea or other change of bowel habit
• PR bleeding or mucous
• fever

Signs

• tender abdomen - especially LIF
• palpable mass
• distention

Investigations

• routine bloods: FBC, CRP, U&E
• blood cultures if septic
• AXR if consider obstruction/perforation

Management

If systemically well:

• consider a no antibiotic prescribing strategy
• simple analgesia
• advise the person to re-present if symptoms persist or worsen.

If systemically unwell, immunosuppressed or has significant comorbidity:

• Oral antibiotics - co-amoxyclav or, if sensitive, trimethoprim + metronidazole or cephalexin + metronidazole
• IV antibiotics for those with complicated diverticulitis - eg. perforation, obstruction, abscess, fistula, and sepsis
• referral to Surgical Team if thought to be complicated