Acute Diverticulitis

Diverticulitis of the colon is an extremely common disease accounting for close to 300,000 hospital admissions each year in the United States. The disease involves perforation of diverticula, which are herniations of the bowel mucosa through the bowel wall at points of intrinsic weakness. They most often occur in the sigmoid colon. Diet, specifically a low-fiber diet, has long been considered a causative factor, leading to constipation and increased colonic pressures. Recent studies have examined obesity and smoking as risk factors, but no definite conclusions have been reached. Patients with diverticulitis most often demonstrate left lower quadrant pain, fever, and other signs of sepsis. Presentation and clinical course can range from mild to severe, including an acute abdomen in cases of free perforation. Diagnosis may be confusing, and other causes of acute abdomen must be considered, including perforated colorectal cancer. Currently, computed tomography (CT) is considered the standard of care and can also provide guidance for the therapeutic option of percutaneous drainage. Treatment of acute diverticulitis must be individualized to the patient's clinical presentation and consists of antibiotic treatment, possible drainage, and possible surgical intervention if needed for source control. Treatment of patients who are initially treated without surgery is an area of debate. Currently the American Society of Colon and Rectal Surgeons (ASCRS) recommends an individualized approach for each patient based on age, comorbidities, and frequency and intensity of attacks.