Diverticular Disease: Diagnosis and Treatment

Diagnosis

• History and physical examination and blood testing are the initial steps. They cannot make the diagnosis, but they may raise suspicion. In particular, the combination of left lower abdominal pain, fever, and elevated white blood cell count suggests diverticulitis.
  
• Abdominal CT scan is the test of choice to diagnose diverticulosis and diverticulitis.
  
• If diverticular bleeding is suspected, a colonoscopy is the test of choice to confirm the diagnosis and identify the site of bleeding.
  
• Colonoscopy with biopsy to rule out colon cancer should be performed after the initial event has subsided.

Treatment

• Nutrition is the primary consideration for prevention and treatment. The risk of developing diverticula can be reduced by increasing fiber intake, either through high–fiber foods or fiber supplements, along with other diet changes (see Nutritional Considerations).
• Diverticulosis itself does not require treatment.
  
• Diverticulitis generally requires hospitalization, intravenous fluids, and antibiotics.
  
  Patients with diverticulitis have a 40 percent risk of recurrence after the initial episode and an 80 percent risk of recurrence following a second episode. To prevent recurrence, many patients will require surgical removal of the involved section of the colon.
• Diverticular bleeding, if severe or recurrent, may require hospitalization, intravenous fluids, blood transfusions, and surgical removal of the involved area of colon.