Diverticular Disease: Diagnosis and Treatment

Diagnosis

Asymptomatic diverticulosis is often incidentally identified on colonoscopy, abdominal CT scan, or barium enema.

If diverticular bleeding is suspected, a colonoscopy may identify the site of bleeding and confirm the presence of diverticula. Upper GI endoscopy should also be performed to rule out upper GI bleeding.

Diverticulitis is suggested by the triad of left lower abdominal pain, fever, and leukocytosis. Abdominal CT scan is the diagnostic test of choice.

Colonoscopy and barium enema may increase the risk of colonic perforation and are contraindicated in acute diverticulitis.

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 may be reduced by increasing fiber intake, either through high–fiber foods or psyllium–based fiber supplements, along with other diet changes (see Nutritional Considerations below).

Uncomplicated diverticulitis is treated with bowel rest (no oral intake of food, drink, or medications) and intravenous antibiotics.

Patients with acute diverticulitis have a 40% risk of recurrence and 80% risk of recurrence following the second episode. Thus, recurrent cases of diverticulitis often require resection of the involved colon.

Diverticulitis complicated by fistula formation, colonic perforation, or bowel obstruction is treated emergently with resection of the involved portion of the colon and colostomy formation.

Diverticular bleeding, if severe or recurrent, may require immediate fluid resuscitation and blood transfusion, along with resection of the involved area of colon.