Management of Diverticular disease
Diverticular disease is a problem of the colon (90% in descending colon)
and is related to lack of fi bre in the diet. It is usually symptomless.
Clinical features
• Typical in middle aged or elderly > 40 yrs
• Diverticulosis—symptomless
• Diverticulitis—infected diverticula and symptomatic constipation or
alternating constipation/diarrhoea
– intermittent cramping lower abdominal pain in LIF
– tenderness in LIF
– rectal bleeding may be profuse (± faeces)
– may present as acute abdomen or subacute obstruction
– usually settles in 2–3 d
Investigations
• WBC and ESR—to determine infl ammation
• Sigmoidoscopy
• Barium enema
• US/CT scan (acute disease)
Management
High-fi bre diet
Symptomatic
• fi bre supplements
• antispasmodics
Diverticulitis (mild)
Amoxycillin + clavulanate 875 mg (o) bd, 5–10 d
Diverticulitis (complicated)
• Nil orally, IV fl uids, analgesics
• Antibiotics
• (Amoxy) ampicillin IV + gentamicin IV + metronidazole IV
Diverticular disease is a problem of the colon (90% in descending colon)
and is related to lack of fi bre in the diet. It is usually symptomless.
Clinical features
• Typical in middle aged or elderly > 40 yrs
• Diverticulosis—symptomless
• Diverticulitis—infected diverticula and symptomatic constipation or
alternating constipation/diarrhoea
– intermittent cramping lower abdominal pain in LIF
– tenderness in LIF
– rectal bleeding may be profuse (± faeces)
– may present as acute abdomen or subacute obstruction
– usually settles in 2–3 d
Investigations
• WBC and ESR—to determine infl ammation
• Sigmoidoscopy
• Barium enema
• US/CT scan (acute disease)
Management
High-fi bre diet
Symptomatic
• fi bre supplements
• antispasmodics
Diverticulitis (mild)
Amoxycillin + clavulanate 875 mg (o) bd, 5–10 d
Diverticulitis (complicated)
• Nil orally, IV fl uids, analgesics
• Antibiotics
• (Amoxy) ampicillin IV + gentamicin IV + metronidazole IV