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Diverticulitis, Emergency Medicine

Reviewed 06/2017
 


Basics

Description

  • Micro- or macroscopic perforation of diverticulum

    • Uncomplicated (75%) vs. complicated

  • Incidence increasing

    • Obesity is a risk factor

Etiology

  • Fecal material in diverticulum hardens, formin...

Diagnosis

Signs and Symptoms

History

  • Symptoms typically develop over days

    • Almost 50% have had prior episodes of pain

  • Left lower quadrant pain in 70% of cases in Western countries

    • Initially vague, then loca...

Treatment

Pre-Hospital

IV fluids 

Initial Stabilization/Therapy

  • Fluid resuscitation with 0.9% normal saline

  • Bowel rest

    • NPO or clear liquid diet

    • Nasogastric tube (NG) tube if persistent vomiting or bowel obs...

Follow-Up

Disposition

Admission Criteria

  • Intractable pain and/or vomiting

  • High fever

  • Peritonitis

  • Failure to respond to outpatient management

  • Severe disease on CT scan

  • Significant leukocytosis

  • Immunocompromise...

Pearls and Pitfalls

  • CT scanning differentiates diverticulitis as complicated or uncomplicated:

    • Surgery reserved for complicated cases, but nonoperative management becoming more prevalent

  • Most cases of u...

Additional Reading

  • Lorimer  JW, Doumit  G. Comorbidity is a major determinant of severity in acute diverticulitis. Am J Surg.  2007;193:681–685.

  • Nelson  RS, Ewing  BM, Wengert  TJ, et al. Clinical...

Codes

ICD9

  • 562.11 Diverticulitis of colon (without mention of hemorrhage)

  • 562.13 Diverticulitis of colon with hemorrhage

ICD10

  • K57.20 Diverticulitis of large intestine with perforation and abscess without...

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