How to Treat an Uncomplicated Diverticulitisgerman translation / full article
A 67 year old female patient approaches her family physician with left sided lower abdominal pain which started a day ago. Diverticular disease is already known from a recent colonoscopy. Physical examination reveals a tender lower left quadrant without overt signs of peritonitis. Her body temperature is slightly elevated (37.7oC). CRP is elevated (60 mg/l) and her blood count shows moderate leucocytosis.
Is there a necessity for further diagnostic procedures?
Is there a recommendation for antibiotic therapy?
In cases of typical clinical presentation and physical examination the diagnosis of acute diverticulitis can be made on a clinical basis. Limited sensitivity of unclear clinical presentation and suspicion of complications require further imaging diagnostics. Plain x-ray examinations can reliably detect pneumoperitoneum and ileus. Computerized tomography (CT) possesses the highest sensitivity (better than ultrasound) to detect acute diverticulitis and related complications. Both CT and ultrasound (US) have a high specificity.
Most practice guidelines recommend antibiotic therapy of acute diverticulitis which can be administered orally and in the ambulatory setting. In a randomized controlled trial published in 2012 the necessity of antibiotic treatment was challenged, because no significant difference could be shown between antibiotic treatment and control regarding complications. However, this negative superiority trial may possibly have been insufficiently powered and thus does not prove equivalence.