Diverticulitis medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];
Overview
An initial episode of acute diverticulitis is usually treated with conservative medical management, including bowel rest, IV fluid resuscitation, and broad-spectrum antimicrobial therapy which covers anaerobic bacteria and gram-negative rods. Patients who have recurring acute attacks or who develop diverticulitis-associated complications, such as peritonitis, abscess, or fistula, require surgery, either immediately or on an elective basis.
Medical Therapy
Uncomplicated Diverticulitis
- A 7-10 days of oral broad-spectrum antibiotic therapy is the first-line of therapy for acute uncomplicated diverticulitis.[1]
- Hospital is indicated in all patients who are elderly, those with compromised immune systems, other comorbidities, cannot tolerate oral hydration, or fails to improve despite appropriate antibiotic therapy. The aim of hospital admission is bowel rest]], nasogastric tube placement, and parenteral antibiotics.[2]
- Outpatients should be advised to follow a liquid diet for 2-3 days, after which a regular diet may be resumed slowly. Hospitalized patients are usually on NPO (Nothing Per Os) status with intravenous hydration, but a liquid diet may be allowed depending on the severity.
- There is no scientific evidence that suggests that a low residue diet prevents the progression of diverticulosis to an acute case of diverticulitis.[3] [4]
- Routine colonoscopy is recommended after the resolution of the attack, to exclude colon cancer, or any other possible cause.[5]
Complicated Diverticulitis
Surgical intervention is the mainstay of therapy for cases of complicated acute diverticulitis which include:[6]
- Peritonitis
- Failed percutaneous drainage of an abscess
- Enterocutaneous fistula formation
- Bowel obstruction
References
- ↑ Mandell, Gerald L.; Bennett, John E. (John Eugene); Dolin, Raphael. (2010). Mandell, Douglas, and Bennett's principles and practice of infectious disease. Philadelphia, PA: Churchill Livingstone/Elsevier. ISBN 978-0-443-06839-3.
- ↑ Mandell, Gerald L.; Bennett, John E. (John Eugene); Dolin, Raphael. (2010). Mandell, Douglas, and Bennett's principles and practice of infectious disease. Philadelphia, PA: Churchill Livingstone/Elsevier. ISBN 978-0-443-06839-3.
- ↑ Schechter S, Mulvey J, Eisenstat TE (1999). "Management of uncomplicated acute diverticulitis: results of a survey". Dis Colon Rectum. 42 (4): 470–5, discussion 475-6. PMID 10215046.
- ↑ Steven Schechter, Joan Mulvey and Theodore E. Eisenstat (April 1999). "Management of uncomplicated acute diverticulitis". 42 (4): 470–475. doi:10.1007/BF02234169. Retrieved 2008-02-12. Text " Diseases of the Colon & Rectum " ignored (help)
- ↑ Lau KC, Spilsbury K, Farooque Y, Kariyawasam SB, Owen RG, Wallace MH; et al. (2011). "Is colonoscopy still mandatory after a CT diagnosis of left-sided diverticulitis: can colorectal cancer be confidently excluded?". Dis Colon Rectum. 54 (10): 1265–70. doi:10.1097/DCR.0b013e31822899a2. PMID 21904141.
- ↑ Sheth AA, Longo W, Floch MH (2008). "Diverticular disease and diverticulitis". Am J Gastroenterol. 103 (6): 1550–6. doi:10.1111/j.1572-0241.2008.01879.x. PMID 18479497.