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Diverticulosis, Emergency Medicine

Reviewed 06/2017
 


Basics

Description

  • Single (diverticulum) or multiple (diverticula) colonic wall outpouchings from colonic muscle dysfunction, usually acquired

  • Sequence:

    • Insufficient amounts of dietary fiber cause dimini...

Diagnosis

Signs and Symptoms

History

  • Chronic or intermittent abdominal pain

    • Often precipitated by eating

    • Sometimes relieved by flatulence or bowel movement

  • Change in bowel pattern

    • Constipation or diarrhea

  • Dy...

Treatment

Pre-Hospital

  • Avoid opiates in abdominal pain when underlying cause is uncertain.

  • Establish 2 large-bore IV lines

  • For significant bleeding or hypotension:

    • 1–2 L (20 mL/kg) bolus 0.9% NS intraveno...

Follow-Up

Disposition

Admission Criteria

  • ICU if unstable with massive hemorrhagic diverticulosis

  • Mild or intermittent hemorrhagic diverticulosis that is otherwise stable so as to determine site of bleedi...

Pearls and Pitfalls

  • 15% with hematochezia have an upper GI source

  • Most cases (75–95%) resolve spontaneously or with conservative management

  • Massive blood loss seen in 9–19% of patients, especially those...

Additional Reading

  • Bono  MJ. Lower gastrointestinal tract bleeding. Emerg Med Clin North Am.  1996;14(3):547–556.

  • Köhler  L, Sauerland  S, Neugebauer  E. Diagnosis and treatment of diverticular di...

Codes

ICD9

  • 562.10 Diverticulosis of colon (without mention of hemorrhage)

  • 562.12 Diverticulosis of colon with hemorrhage

  • 751.5 Other anomalies of intestine

ICD10

  • K57.30 Dvrtclos of lg int w/o perforation o...

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