Diverticulitis Treatment with Medicine and Surgery

Diverticulitis is a medical problem that occurs when weakened out-pouchings in the intestinal wall, called diverticula, develop microperforations. The subsequent inflammation and/or infection cause symptoms of abdominal pain, fever, and more. There are two types of diverticulitis, uncomplicated and complicated. The two types each require a different treatment approach.

Uncomplicated diverticulitis is treated with simple bowel rest (clear liquids only) and antibiotics. This regimen works in over 70% of patients with simple diverticulitis. Some patients may need to be admitted to the hospital for this conservative management while others can be treated on an outpatient basis. This decision depends on individual factors, such as whether the individual can maintain adequate fluid intake while not eating and whether they can follow up closely with their physician or seek rapid medical care for a change in status such as increased fever or abdominal pain.

Most patients with uncomplicated diverticulitis will begin to see improvement in their symptoms within two to three days of antibiotics and a clear liquid diet. At this point, the diet can be slowly advanced to full liquids and then a regular diet.

The antibiotics used to treat diverticulitis on an outpatient basis must be active against common intra-abdominal bacteria such as gram negative rods and anaerobes. Antibiotics frequently used in diverticulitis include ciprofloxacin (Cipro) or levofloxacin (Levaquin) with metronidazole (Flagyl), amoxicillin-clavulanate (Augmentin), or trimethoprim-sulfamethoxazole (Bactrim). These antibiotics are used for 7 to 10 days.

Individuals who require hospitalization for treatment of diverticulitis should be started on empiric broad-spectrum IV antibiotics while awaiting culture results of the fluid drained from the infected site. This fluid may be drained by the introduction of a needle and tube through the skin, known as percutaneous drainage, or by surgical drainage. A commonly used broad-spectrum antibiotic for complicated diverticulitis is piperacillin-tazobactam (Zosyn). Patients with an allergy to beta-lactam antibiotics are often treated with ertapenem (Invanz).

Complicated diverticulitis requires surgical management. Abscesses may often be drained percutaneously using interventional radiology for CT-guided drainage. The tube or catheter is left in place till the drainage is less than 10ml in 24 hours. It may take days to weeks to achieve this goal.

In some patients, laparotomy (abdominal incision and exploration) performed in the operating room. This is required if the patient has signs of diffuse peritonitis, an abscess that is nondrainable or the patients condition worsens despite drainage. In these cases it is also advisable to consider alternate diagnoses such as appendicitis, Crohn's disease, ischemic colitis, ovarian cyst or torsion, and/or ectopic pregnancy.

Once an individual has recovered from a bout of diverticulitis, they may be able to reduce their risk of a future episode by increasing fiber intake. A high fiber diet and/or the long-term use of a fiber supplement appears to reduce the recurrence of diverticulitis in some patients. In the past, people with diverticulitis were advised to avoid seeds, popcorn and nuts on the thought that these small food items may get stuck in diverticuli. However, this association has never been proven and is no longer the standard of care.

At two to six weeks after recovery from diverticulitis, patients should have a colonoscopy. The colonoscopy is performed to evaluate the severity of the diverticulosis and to rule out any other colonic problems such as colorectal cancer. In addition, individuals who are less than 40 years of age or who are immunosuppressed may benefit from elective surgery to prevent future episodes of diverticulitis.