Diverticulitis - Revision history

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2026-03-22T09:29:35Z

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2026-03-20T10:53:08Z

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Ostermayer at 16:31, 10 March 2026

2026-03-10T16:31:40Z

Ostermayer at 16:29, 10 March 2026

2026-03-10T16:29:48Z

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2026-01-04T22:48:41Z

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Rossdonaldson1: /* Background */

2025-09-24T21:05:18Z

Background

← Revisión anterior		Revisión del 21:05 24 sep 2025
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	==Background==		==Background==
	[[File:Diverticula, sigmoid colon.jpg\|thumb\|Section of the large bowel (sigmoid colon) showing multiple pouches (diverticula). The diverticula appear on either side of the longitudinal muscle bundle (taenium) which runs horizontally across the specimen in an arc.]]		[[File:Diverticula, sigmoid colon.jpg\|thumb\|Section of the large bowel (sigmoid colon) showing multiple pouches (diverticula). The diverticula appear on either side of the longitudinal muscle bundle (taenium) which runs horizontally across the specimen in an arc.]]
			[[File:Diameters of the large intestine.png\|thumb\|Average inner diameters and ranges of different sections of the large intestine.<ref> Nguyen H, Loustaunau C, Facista A, Ramsey L, Hassounah N, Taylor H, et al. (July 2010). "Deficient Pms2, ERCC1, Ku86, CcOI in field defects during progression to colon cancer". Journal of Visualized Experiments (41). doi:10.3791/1931. PMC 3149991. PMID 20689513.</ref>]]
	*Prevalence of [[diverticulosis]] 30% by age 60, >70% by age 85		*Prevalence of [[diverticulosis]] 30% by age 60, >70% by age 85
	*70% of patients with diverticulosis remain asymptomatic		*70% of patients with diverticulosis remain asymptomatic

Kxl328: /* Complicated */

2025-03-24T00:07:31Z

Complicated

← Revisión anterior		Revisión del 00:07 24 mar 2025
Línea 66:		Línea 66:
	*Defined as having a phlegmon, abscess, stricture, obstruction, fistula, or perforation (i.e. [[Hinchey]] Stages I-IV; see Evaluation section)		*Defined as having a phlegmon, abscess, stricture, obstruction, fistula, or perforation (i.e. [[Hinchey]] Stages I-IV; see Evaluation section)
	*Antibiotic choice<ref>Carns et al. Clinical impacts of utilizing ceftriaxone and metronidazole versus piperacillin/tazobactam in patients diagnosed with complicated diverticulitis. Am J Surg		*Antibiotic choice<ref>Carns et al. Clinical impacts of utilizing ceftriaxone and metronidazole versus piperacillin/tazobactam in patients diagnosed with complicated diverticulitis. Am J Surg
	. 2025 Mar:241:116195. doi: 10.1016/j.amjsurg.2025.116195.</ref>		. 2025 Mar:241:116195. doi: 10.1016/j.amjsurg.2025.116195.</ref>:
	**[[Ceftriaxone]] PLUS [[metronidazole]]		**[[Ceftriaxone]] PLUS [[metronidazole]]
	**OR [[piperacillin/tazobactam]]		**OR [[piperacillin/tazobactam]]

Kxl328: /* Management */

2025-03-24T00:06:25Z

Management

← Revisión anterior		Revisión del 00:06 24 mar 2025
Línea 54:		Línea 54:
	==Management==		==Management==
	*Antibiotics should be used only for select patients and not routinely in acute uncomplicated diverticulitis<ref>Stollman N, Smalley W, and Hirano I. American Gastroenterological Association Institute guideline on the management of acute diverticulitis. Gastroenterology. 2015; 149(7):1944-1949. </ref>		*Antibiotics should be used only for select patients and not routinely in acute uncomplicated diverticulitis<ref>Stollman N, Smalley W, and Hirano I. American Gastroenterological Association Institute guideline on the management of acute diverticulitis. Gastroenterology. 2015; 149(7):1944-1949. </ref>
	*Antibiotics are aimed at treating [[Gram Negative]] organisms and [[Anaerobes]] (Enterobacteriaceae~~, [[Pseudomonas aeruginosa]]~~, [[Bacteroides fragilis\|Bacteriodes sp.]], and Enterococci)<ref>Tursi, A. et al. Diverticular disease: A therapeutic overview. World J Gastrointest Pharmacol Ther. Feb 6, 2010; 1(1): 27–35</ref>		*Antibiotics are aimed at treating [[Gram Negative]] organisms and [[Anaerobes]] (Enterobacteriaceae, [[Bacteroides fragilis\|Bacteriodes sp.]], and Enterococci)<ref>Tursi, A. et al. Diverticular disease: A therapeutic overview. World J Gastrointest Pharmacol Ther. Feb 6, 2010; 1(1): 27–35</ref>
	===Uncomplicated===		===Uncomplicated===
	''Current research suggests that antibiotics '''may not be necessary in uncomplicated diverticulitis''' if patient receives sufficient bowel rest in coordination with medicine observation and close follow up. Antibiotics do not shorten time to recovery or decrease rate of recurrence. At the very least, shorter durations (5 days) of antibiotics should be prefered compared to historic 10-14day courses''<ref>Chabok A. Randomized clinical trial of antibiotics in acute uncomplicated diverticulitis. Br J Surg. 2012 Apr;99(4):532-9. doi: 10.1002/bjs.8688</ref><ref>The STAND trial: Jaung R, Nisbet S, Gosselink MP, Di Re A, Keane C, Lin A, Milne T, Su’a B, Rajaratnam S, Ctercteko G, Hsee L, Rowbotham D, Hill A, Bissett I. Antibiotics Do Not Reduce Length of Hospital Stay for Uncomplicated Diverticulitis in a Pragmatic Double-Blind Randomized Trial. Clin Gastroenterol Hepatol. 2020 Mar 30:S1542-3565(20)30426-2. doi: 10.1016/j.cgh.2020.03.049. PMID: 32240832</ref>		''Current research suggests that antibiotics '''may not be necessary in uncomplicated diverticulitis''' if patient receives sufficient bowel rest in coordination with medicine observation and close follow up. Antibiotics do not shorten time to recovery or decrease rate of recurrence. At the very least, shorter durations (5 days) of antibiotics should be prefered compared to historic 10-14day courses''<ref>Chabok A. Randomized clinical trial of antibiotics in acute uncomplicated diverticulitis. Br J Surg. 2012 Apr;99(4):532-9. doi: 10.1002/bjs.8688</ref><ref>The STAND trial: Jaung R, Nisbet S, Gosselink MP, Di Re A, Keane C, Lin A, Milne T, Su’a B, Rajaratnam S, Ctercteko G, Hsee L, Rowbotham D, Hill A, Bissett I. Antibiotics Do Not Reduce Length of Hospital Stay for Uncomplicated Diverticulitis in a Pragmatic Double-Blind Randomized Trial. Clin Gastroenterol Hepatol. 2020 Mar 30:S1542-3565(20)30426-2. doi: 10.1016/j.cgh.2020.03.049. PMID: 32240832</ref>
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	===Complicated===		===Complicated===
	*Defined as having a phlegmon, abscess, stricture, obstruction, fistula, or perforation (i.e. [[Hinchey]] Stages I-IV; see Evaluation section)		*Defined as having a phlegmon, abscess, stricture, obstruction, fistula, or perforation (i.e. [[Hinchey]] Stages I-IV; see Evaluation section)
			*Antibiotic choice<ref>Carns et al. Clinical impacts of utilizing ceftriaxone and metronidazole versus piperacillin/tazobactam in patients diagnosed with complicated diverticulitis. Am J Surg
			. 2025 Mar:241:116195. doi: 10.1016/j.amjsurg.2025.116195.</ref>
			**[[Ceftriaxone]] PLUS [[metronidazole]]
			**OR [[piperacillin/tazobactam]]
	*Bowel rest in coordination with antibiotics		*Bowel rest in coordination with antibiotics
	*Surgical consult for drainage of [[abscess]] or further surgical intervention		*Surgical consult for drainage of [[abscess]] or further surgical intervention

Ostermayer: /* Uncomplicated */

2022-09-30T12:32:49Z

Uncomplicated

← Revisión anterior		Revisión del 12:32 30 sep 2022
Línea 56:		Línea 56:
	*Antibiotics are aimed at treating [[Gram Negative]] organisms and [[Anaerobes]] (Enterobacteriaceae, [[Pseudomonas aeruginosa]], [[Bacteroides fragilis\|Bacteriodes sp.]], and Enterococci)<ref>Tursi, A. et al. Diverticular disease: A therapeutic overview. World J Gastrointest Pharmacol Ther. Feb 6, 2010; 1(1): 27–35</ref>		*Antibiotics are aimed at treating [[Gram Negative]] organisms and [[Anaerobes]] (Enterobacteriaceae, [[Pseudomonas aeruginosa]], [[Bacteroides fragilis\|Bacteriodes sp.]], and Enterococci)<ref>Tursi, A. et al. Diverticular disease: A therapeutic overview. World J Gastrointest Pharmacol Ther. Feb 6, 2010; 1(1): 27–35</ref>
	===Uncomplicated===		===Uncomplicated===
	''Current research suggests that antibiotics may not be necessary in uncomplicated diverticulitis if patient receives sufficient bowel rest in coordination with medicine observation and close follow up. Antibiotics do not shorten time to recovery or decrease rate of recurrence. At the very least, shorter durations (5 days) of antibiotics should be prefered compared to historic 10-14day courses''<ref>Chabok A. Randomized clinical trial of antibiotics in acute uncomplicated diverticulitis. Br J Surg. 2012 Apr;99(4):532-9. doi: 10.1002/bjs.8688</ref><ref>The STAND trial: Jaung R, Nisbet S, Gosselink MP, Di Re A, Keane C, Lin A, Milne T, Su’a B, Rajaratnam S, Ctercteko G, Hsee L, Rowbotham D, Hill A, Bissett I. Antibiotics Do Not Reduce Length of Hospital Stay for Uncomplicated Diverticulitis in a Pragmatic Double-Blind Randomized Trial. Clin Gastroenterol Hepatol. 2020 Mar 30:S1542-3565(20)30426-2. doi: 10.1016/j.cgh.2020.03.049. PMID: 32240832</ref>		''Current research suggests that antibiotics '''may not be necessary in uncomplicated diverticulitis''' if patient receives sufficient bowel rest in coordination with medicine observation and close follow up. Antibiotics do not shorten time to recovery or decrease rate of recurrence. At the very least, shorter durations (5 days) of antibiotics should be prefered compared to historic 10-14day courses''<ref>Chabok A. Randomized clinical trial of antibiotics in acute uncomplicated diverticulitis. Br J Surg. 2012 Apr;99(4):532-9. doi: 10.1002/bjs.8688</ref><ref>The STAND trial: Jaung R, Nisbet S, Gosselink MP, Di Re A, Keane C, Lin A, Milne T, Su’a B, Rajaratnam S, Ctercteko G, Hsee L, Rowbotham D, Hill A, Bissett I. Antibiotics Do Not Reduce Length of Hospital Stay for Uncomplicated Diverticulitis in a Pragmatic Double-Blind Randomized Trial. Clin Gastroenterol Hepatol. 2020 Mar 30:S1542-3565(20)30426-2. doi: 10.1016/j.cgh.2020.03.049. PMID: 32240832</ref>
	*Modified [[Hinchey]] Class 0		*Modified [[Hinchey]] Class 0
	*Liquid diet and bowel rest (low fiber foods) are most important		*Liquid diet and bowel rest (low fiber foods) are most important

Ostermayer: /* Uncomplicated */

2022-09-30T12:32:32Z

Uncomplicated

← Revisión anterior		Revisión del 12:32 30 sep 2022
Línea 56:		Línea 56:
	*Antibiotics are aimed at treating [[Gram Negative]] organisms and [[Anaerobes]] (Enterobacteriaceae, [[Pseudomonas aeruginosa]], [[Bacteroides fragilis\|Bacteriodes sp.]], and Enterococci)<ref>Tursi, A. et al. Diverticular disease: A therapeutic overview. World J Gastrointest Pharmacol Ther. Feb 6, 2010; 1(1): 27–35</ref>		*Antibiotics are aimed at treating [[Gram Negative]] organisms and [[Anaerobes]] (Enterobacteriaceae, [[Pseudomonas aeruginosa]], [[Bacteroides fragilis\|Bacteriodes sp.]], and Enterococci)<ref>Tursi, A. et al. Diverticular disease: A therapeutic overview. World J Gastrointest Pharmacol Ther. Feb 6, 2010; 1(1): 27–35</ref>
	===Uncomplicated===		===Uncomplicated===
	''Current research suggests that antibiotics may not be necessary in uncomplicated diverticulitis if patient receives sufficient bowel rest in coordination with medicine observation and close follow up. Antibiotics do not ~~speed~~ recovery or rate of recurrence. At the very least, shorter durations (5 days) of antibiotics should be prefered compared to historic 10-14day courses''<ref>Chabok A. Randomized clinical trial of antibiotics in acute uncomplicated diverticulitis. Br J Surg. 2012 Apr;99(4):532-9. doi: 10.1002/bjs.8688</ref><ref>The STAND trial: Jaung R, Nisbet S, Gosselink MP, Di Re A, Keane C, Lin A, Milne T, Su’a B, Rajaratnam S, Ctercteko G, Hsee L, Rowbotham D, Hill A, Bissett I. Antibiotics Do Not Reduce Length of Hospital Stay for Uncomplicated Diverticulitis in a Pragmatic Double-Blind Randomized Trial. Clin Gastroenterol Hepatol. 2020 Mar 30:S1542-3565(20)30426-2. doi: 10.1016/j.cgh.2020.03.049. PMID: 32240832</ref>		''Current research suggests that antibiotics may not be necessary in uncomplicated diverticulitis if patient receives sufficient bowel rest in coordination with medicine observation and close follow up. Antibiotics do not shorten time to recovery or decrease rate of recurrence. At the very least, shorter durations (5 days) of antibiotics should be prefered compared to historic 10-14day courses''<ref>Chabok A. Randomized clinical trial of antibiotics in acute uncomplicated diverticulitis. Br J Surg. 2012 Apr;99(4):532-9. doi: 10.1002/bjs.8688</ref><ref>The STAND trial: Jaung R, Nisbet S, Gosselink MP, Di Re A, Keane C, Lin A, Milne T, Su’a B, Rajaratnam S, Ctercteko G, Hsee L, Rowbotham D, Hill A, Bissett I. Antibiotics Do Not Reduce Length of Hospital Stay for Uncomplicated Diverticulitis in a Pragmatic Double-Blind Randomized Trial. Clin Gastroenterol Hepatol. 2020 Mar 30:S1542-3565(20)30426-2. doi: 10.1016/j.cgh.2020.03.049. PMID: 32240832</ref>
	*Modified [[Hinchey]] Class 0		*Modified [[Hinchey]] Class 0
	*Liquid diet and bowel rest (low fiber foods) are most important		*Liquid diet and bowel rest (low fiber foods) are most important

← Revisión anterior		Revisión del 09:29 22 mar 2026
Línea 50:		Línea 50:

	*Includes transplant recipients, chronic [[corticosteroids\|corticosteroid]] use, active chemotherapy, [[HIV\|HIV/AIDS]], chronic [[renal failure\|renal failure]], biologic immunosuppression		*Includes transplant recipients, chronic [[corticosteroids\|corticosteroid]] use, active chemotherapy, [[HIV\|HIV/AIDS]], chronic [[renal failure\|renal failure]], biologic immunosuppression
	*May present with ~~'''~~milder symptoms~~'''~~ (blunted fever, less tenderness, less leukocytosis) leading to ~~'''~~delayed diagnosis~~'''~~ and more advanced disease at presentation<ref name="AGA2021"/><ref name="WSES2020"/><ref name="Sangster2023">Sangster GP, et al. Acute diverticulitis in immunocompromised patients: evidence from WIRES-T. Tech Coloproctol. 2023;27(8):667-676. doi:10.1007/s10151-023-02758-6</ref>		*May present with milder symptoms (blunted fever, less tenderness, less leukocytosis) leading to delayed diagnosis and more advanced disease at presentation<ref name="AGA2021"/><ref name="WSES2020"/><ref name="Sangster2023">Sangster GP, et al. Acute diverticulitis in immunocompromised patients: evidence from WIRES-T. Tech Coloproctol. 2023;27(8):667-676. doi:10.1007/s10151-023-02758-6</ref>
	*Higher risk of failure of non-operative management, higher emergency surgery rate, and significantly higher mortality (20% vs 5% in immunocompetent)<ref name="Biondo2016">Biondo S, et al. Diverticulitis in immunosuppressed patients: A fatal outcome requiring a new approach? Can J Surg. 2016;59(4):254-259. doi:10.1503/cjs.014915</ref>		*Higher risk of failure of non-operative management, higher emergency surgery rate, and significantly higher mortality (20% vs 5% in immunocompetent)<ref name="Biondo2016">Biondo S, et al. Diverticulitis in immunosuppressed patients: A fatal outcome requiring a new approach? Can J Surg. 2016;59(4):254-259. doi:10.1503/cjs.014915</ref>
	*~~'''~~Always obtain CT imaging~~'''~~ even in mild presentations<ref name="AGA2021"/>		*Always obtain CT imaging even in mild presentations<ref name="AGA2021"/>
	*'''Always treat with antibiotics''' (do NOT withhold in this population)<ref name="AGA2021"/>		*'''Always treat with antibiotics''' (do NOT withhold in this population)<ref name="AGA2021"/>
	*Low threshold for surgical consult<ref name="AGA2021"/>		*Low threshold for surgical consult<ref name="AGA2021"/>
Línea 82:		Línea 82:
	**[[Blood type and screen\|Type and screen]] if surgical intervention considered		**[[Blood type and screen\|Type and screen]] if surgical intervention considered
	*Imaging		*Imaging
	**CT with IV and PO contrast (Sn 97%, Sp 100%) — ~~'''~~gold standard~~'''~~		**CT with IV and PO contrast (Sn 97%, Sp 100%) — gold standard
	***Pericolic stranding		***Pericolic stranding
	***Bowel wall thickening		***Bowel wall thickening
Línea 101:		Línea 101:
	===When to Image===		===When to Image===

	*Stable patient with history of ~~'''~~prior CT-confirmed~~'''~~ diverticulitis presenting with identical symptoms does not require repeat imaging		*Stable patient with history of prior CT-confirmed diverticulitis presenting with identical symptoms does not require repeat imaging
	*~~'''~~First-time episode~~'''~~ or current episode different from previous requires diagnostic imaging<ref name="AGA2021"/>		*First-time episode or current episode different from previous requires diagnostic imaging<ref name="AGA2021"/>
	*Always image immunocompromised patients regardless of severity<ref name="AGA2021"/>		*Always image immunocompromised patients regardless of severity<ref name="AGA2021"/>
	*Always image patients who fail to improve on therapy<ref name="AGA2021"/>		*Always image patients who fail to improve on therapy<ref name="AGA2021"/>
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	==Management==		==Management==

	*Antibiotics should be used ~~'''~~selectively~~'''~~ and not routinely in acute uncomplicated diverticulitis<ref name="AGA2015">Stollman N, Smalley W, and Hirano I. American Gastroenterological Association Institute guideline on the management of acute diverticulitis. Gastroenterology. 2015; 149(7):1944-1949.</ref><ref name="AGA2021"/>		*Antibiotics should be used selectively and not routinely in acute uncomplicated diverticulitis<ref name="AGA2015">Stollman N, Smalley W, and Hirano I. American Gastroenterological Association Institute guideline on the management of acute diverticulitis. Gastroenterology. 2015; 149(7):1944-1949.</ref><ref name="AGA2021"/>
	*Antibiotics are aimed at treating [[Gram Negative\|Gram Negative]] organisms and [[Anaerobes\|Anaerobes]] (Enterobacteriaceae, [[Bacteroides fragilis\|Bacteriodes sp.]], and Enterococci)<ref name="Tursi2010">Tursi, A. et al. Diverticular disease: A therapeutic overview. World J Gastrointest Pharmacol Ther. Feb 6, 2010; 1(1): 27–35</ref>		*Antibiotics are aimed at treating [[Gram Negative\|Gram Negative]] organisms and [[Anaerobes\|Anaerobes]] (Enterobacteriaceae, [[Bacteroides fragilis\|Bacteriodes sp.]], and Enterococci)<ref name="Tursi2010">Tursi, A. et al. Diverticular disease: A therapeutic overview. World J Gastrointest Pharmacol Ther. Feb 6, 2010; 1(1): 27–35</ref>

Línea 120:		Línea 120:
	''Current evidence suggests that antibiotics '''may not be necessary''' in immunocompetent patients with mild, uncomplicated diverticulitis (no systemic signs) given sufficient bowel rest and close follow-up. A meta-analysis of 9 studies (2,505 patients) showed no difference in recovery time, readmission, progression to complications, or need for surgery with vs without antibiotics.''<ref name="AGA2021"/><ref name="Chabok2012">Chabok A. Randomized clinical trial of antibiotics in acute uncomplicated diverticulitis. Br J Surg. 2012 Apr;99(4):532-9. doi: 10.1002/bjs.8688</ref><ref name="STAND">Jaung R, Nisbet S, Gosselink MP, et al. Antibiotics Do Not Reduce Length of Hospital Stay for Uncomplicated Diverticulitis in a Pragmatic Double-Blind Randomized Trial. Clin Gastroenterol Hepatol. 2020;S1542-3565(20)30426-2. doi: 10.1016/j.cgh.2020.03.049. PMID: 32240832</ref>		''Current evidence suggests that antibiotics '''may not be necessary''' in immunocompetent patients with mild, uncomplicated diverticulitis (no systemic signs) given sufficient bowel rest and close follow-up. A meta-analysis of 9 studies (2,505 patients) showed no difference in recovery time, readmission, progression to complications, or need for surgery with vs without antibiotics.''<ref name="AGA2021"/><ref name="Chabok2012">Chabok A. Randomized clinical trial of antibiotics in acute uncomplicated diverticulitis. Br J Surg. 2012 Apr;99(4):532-9. doi: 10.1002/bjs.8688</ref><ref name="STAND">Jaung R, Nisbet S, Gosselink MP, et al. Antibiotics Do Not Reduce Length of Hospital Stay for Uncomplicated Diverticulitis in a Pragmatic Double-Blind Randomized Trial. Clin Gastroenterol Hepatol. 2020;S1542-3565(20)30426-2. doi: 10.1016/j.cgh.2020.03.049. PMID: 32240832</ref>

	~~'''~~When to use antibiotics in uncomplicated diverticulitis:~~'''~~<ref name="AGA2021"/>		When to use antibiotics in uncomplicated diverticulitis:<ref name="AGA2021"/>
	*Immunocompromised patients (always)		*Immunocompromised patients (always)
	*Significant comorbidities or frailty		*Significant comorbidities or frailty
Línea 128:		Línea 128:
	*Patient preference or inability to ensure reliable follow-up		*Patient preference or inability to ensure reliable follow-up

	~~'''~~If antibiotics are given:~~'''~~		If antibiotics are given:
	*Shorter courses (~~'''~~4-7 days~~'''~~) are preferred over historic 10-14 day courses<ref name="AGA2021"/><ref name="Chabok2012"/>		*Shorter courses (4-7 days) are preferred over historic 10-14 day courses<ref name="AGA2021"/><ref name="Chabok2012"/>
	*Liquid diet and bowel rest (low fiber foods) are most important		*Liquid diet and bowel rest (low fiber foods) are most important

	~~'''~~Antibiotic Regimen~~'''~~		Antibiotic Regimen
	*{{Uncomplicated Diverticulitis Antibiotics}}		*{{Uncomplicated Diverticulitis Antibiotics}}

Línea 148:		Línea 148:
	====Abscess Management====		====Abscess Management====

	*~~'''~~Small abscess (<4-5 cm):~~'''~~ Initial trial of antibiotics alone (without percutaneous drainage) is reasonable<ref name="WSES2020"/>		*Small abscess (<4-5 cm): Initial trial of antibiotics alone (without percutaneous drainage) is reasonable<ref name="WSES2020"/>
	*~~'''~~Large abscess (>3-4 cm) or failure to improve:~~'''~~ Percutaneous CT- or US-guided drainage plus antibiotics<ref name="Siewert2006">Siewert B et al. Impact of CT-guided drainage in the treatment of diverticular abscesses: size matters. AJR Am J Roentgenol. 2006 Mar;186(3):680-6.</ref>		*Large abscess (>3-4 cm) or failure to improve: Percutaneous CT- or US-guided drainage plus antibiotics<ref name="Siewert2006">Siewert B et al. Impact of CT-guided drainage in the treatment of diverticular abscesses: size matters. AJR Am J Roentgenol. 2006 Mar;186(3):680-6.</ref>
	*If percutaneous drainage is not feasible, initial antibiotic therapy alone may be attempted if clinical condition permits<ref name="WSES2020"/>		*If percutaneous drainage is not feasible, initial antibiotic therapy alone may be attempted if clinical condition permits<ref name="WSES2020"/>

Línea 175:		Línea 175:
	*Comorbid disease		*Comorbid disease
	*High WBC, high fever, elderly		*High WBC, high fever, elderly
	*~~'''~~Immunocompromised~~'''~~ patients (low threshold — consider admission for all)<ref name="AGA2021"/><ref name="WSES2020"/>		*Immunocompromised patients (low threshold — consider admission for all)<ref name="AGA2021"/><ref name="WSES2020"/>
	*Failed outpatient therapy (worsening symptoms or CT findings within 6 weeks of initial episode)		*Failed outpatient therapy (worsening symptoms or CT findings within 6 weeks of initial episode)
	*Large [[abscess\|abscess]] >3-4 cm requiring percutaneous drainage<ref name="Siewert2006"/>		*Large [[abscess\|abscess]] >3-4 cm requiring percutaneous drainage<ref name="Siewert2006"/>
Línea 192:		Línea 192:
	**Have uncomplicated disease on CT (Hinchey 0)		**Have uncomplicated disease on CT (Hinchey 0)
	**Reliable follow-up within 2-3 days		**Reliable follow-up within 2-3 days
	*Outpatient re-evaluation should occur within ~~'''~~7 days~~'''~~; return sooner if worsening<ref name="WSES2020"/>		*Outpatient re-evaluation should occur within 7 days; return sooner if worsening<ref name="WSES2020"/>

	===Follow-Up Counseling===		===Follow-Up Counseling===

	*Refer all newly-diagnosed patients for follow-up ~~'''~~colonoscopy in 6 weeks~~'''~~ (CT cannot reliably rule out carcinoma)<ref name="AGA2021"/><ref name="AGA2015"/>		*Refer all newly-diagnosed patients for follow-up colonoscopy in 6 weeks (CT cannot reliably rule out carcinoma)<ref name="AGA2021"/><ref name="AGA2015"/>
	*~~'''~~Elective surgery~~'''~~ should NOT be recommended based on number of episodes alone; decisions should be individualized based on severity, quality of life, patient preferences, and comorbidities<ref name="AGA2021"/><ref name="WSES2020"/>		*Elective surgery should NOT be recommended based on number of episodes alone; decisions should be individualized based on severity, quality of life, patient preferences, and comorbidities<ref name="AGA2021"/><ref name="WSES2020"/>
	**Exception: immunocompromised patients should be referred for surgical consultation to discuss elective resection after recovery<ref name="WSES2020"/>		**Exception: immunocompromised patients should be referred for surgical consultation to discuss elective resection after recovery<ref name="WSES2020"/>
	*Dietary counseling: high-fiber diet or fiber supplementation after resolution; nuts, seeds, and popcorn are safe<ref name="AGA2015"/>		*Dietary counseling: high-fiber diet or fiber supplementation after resolution; nuts, seeds, and popcorn are safe<ref name="AGA2015"/>
Línea 212:		Línea 212:
	*CRP (when available) can help risk-stratify: CRP >150 mg/L suggests complicated disease<ref name="WSES2020"/>		*CRP (when available) can help risk-stratify: CRP >150 mg/L suggests complicated disease<ref name="WSES2020"/>
	*Antibiotics are NOT needed in all uncomplicated diverticulitis — bowel rest and follow-up may be sufficient in immunocompetent patients without systemic signs		*Antibiotics are NOT needed in all uncomplicated diverticulitis — bowel rest and follow-up may be sufficient in immunocompetent patients without systemic signs
	*The risk of complicated disease is ~~'''~~highest with the first episode~~'''~~, not with recurrences<ref name="AGA2021"/>		*The risk of complicated disease is highest with the first episode, not with recurrences<ref name="AGA2021"/>
	*Younger patients do NOT necessarily have a worse prognosis (prior dogma now debunked)<ref name="StatPearls2024"/>		*Younger patients do NOT necessarily have a worse prognosis (prior dogma now debunked)<ref name="StatPearls2024"/>

← Revisión anterior		Revisión del 16:31 10 mar 2026
Línea 19:		Línea 19:
	*Erosion of diverticular wall by inspissated fecal material leads to microperforation		*Erosion of diverticular wall by inspissated fecal material leads to microperforation
	**Most common pathogens are anaerobes, as well as gram-negative rods		**Most common pathogens are anaerobes, as well as gram-negative rods
	*Emerging data suggest a greater role for the ~~[[Special:MyLanguage/~~microbiome~~\|microbiome]]~~ and genetic predisposition than previously appreciated<ref name="Divert2024">Diverticulitis: A Review of Current and Emerging Practice-Changing Evidence. Clin Colon Rectal Surg. 2024;37(6). doi:10.1055/s-0044-1791284</ref>		*Emerging data suggest a greater role for the microbiome and genetic predisposition than previously appreciated<ref name="Divert2024">Diverticulitis: A Review of Current and Emerging Practice-Changing Evidence. Clin Colon Rectal Surg. 2024;37(6). doi:10.1055/s-0044-1791284</ref>
	*Diverticular bleeding (painless [[Special:MyLanguage/lower gastrointestinal bleeding\|lower gastrointestinal bleeding]]) is NOT associated with diverticulitis		*Diverticular bleeding (painless [[Special:MyLanguage/lower gastrointestinal bleeding\|lower gastrointestinal bleeding]]) is NOT associated with diverticulitis

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	*[[Special:MyLanguage/Obesity\|Obesity]] (BMI ≥30 increases risk ~1.8x; higher BMI correlates with younger age of presentation)<ref name="Strate2009">Strate LL, Liu YL, Aldoori WH, Syngal S, Giovannucci EL. Obesity increases the risks of diverticulitis and diverticular bleeding. Gastroenterology. 2009;136(1):115-122.e1.</ref><ref name="StatPearls2024"/>		*[[Special:MyLanguage/Obesity\|Obesity]] (BMI ≥30 increases risk ~1.8x; higher BMI correlates with younger age of presentation)<ref name="Strate2009">Strate LL, Liu YL, Aldoori WH, Syngal S, Giovannucci EL. Obesity increases the risks of diverticulitis and diverticular bleeding. Gastroenterology. 2009;136(1):115-122.e1.</ref><ref name="StatPearls2024"/>
	*Low-fiber diet, high red meat consumption, sedentary lifestyle<ref name="StatPearls2024"/>		*Low-fiber diet, high red meat consumption, sedentary lifestyle<ref name="StatPearls2024"/>
	*~~[[Special:MyLanguage/~~Smoking~~\|Smoking]]~~ (increases risk of abscess formation and perforation)<ref name="DD2024">Chetwood JD, et al. Diverticular disease: update on pathophysiology, classification and management. Frontline Gastroenterol. 2024;15(1):56-63. doi:10.1136/flgastro-2023-102467</ref>		*Smoking (increases risk of abscess formation and perforation)<ref name="DD2024">Chetwood JD, et al. Diverticular disease: update on pathophysiology, classification and management. Frontline Gastroenterol. 2024;15(1):56-63. doi:10.1136/flgastro-2023-102467</ref>
	*Medications:		*Medications:
	**[[Special:MyLanguage/NSAIDs\|NSAIDs]] (increase mucosal permeability; avoid if possible, aspirin for secondary cardiac prevention is acceptable)<ref name="AGA2021"/><ref name="DD2024"/>		**[[Special:MyLanguage/NSAIDs\|NSAIDs]] (increase mucosal permeability; avoid if possible, aspirin for secondary cardiac prevention is acceptable)<ref name="AGA2021"/><ref name="DD2024"/>
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	===Immunocompromised Patients===		===Immunocompromised Patients===

	*Includes transplant recipients, chronic [[Special:MyLanguage/corticosteroids\|corticosteroid]] use, active ~~[[Special:MyLanguage/~~chemotherapy~~\|chemotherapy]]~~, [[Special:MyLanguage/HIV\|HIV/AIDS]], chronic [[Special:MyLanguage/renal failure\|renal failure]], biologic immunosuppression		*Includes transplant recipients, chronic [[Special:MyLanguage/corticosteroids\|corticosteroid]] use, active chemotherapy, [[Special:MyLanguage/HIV\|HIV/AIDS]], chronic [[Special:MyLanguage/renal failure\|renal failure]], biologic immunosuppression
	*May present with '''milder symptoms''' (blunted fever, less tenderness, less leukocytosis) leading to '''delayed diagnosis''' and more advanced disease at presentation<ref name="AGA2021"/><ref name="WSES2020"/><ref name="Sangster2023">Sangster GP, et al. Acute diverticulitis in immunocompromised patients: evidence from WIRES-T. Tech Coloproctol. 2023;27(8):667-676. doi:10.1007/s10151-023-02758-6</ref>		*May present with '''milder symptoms''' (blunted fever, less tenderness, less leukocytosis) leading to '''delayed diagnosis''' and more advanced disease at presentation<ref name="AGA2021"/><ref name="WSES2020"/><ref name="Sangster2023">Sangster GP, et al. Acute diverticulitis in immunocompromised patients: evidence from WIRES-T. Tech Coloproctol. 2023;27(8):667-676. doi:10.1007/s10151-023-02758-6</ref>
	*Higher risk of failure of non-operative management, higher emergency surgery rate, and significantly higher mortality (20% vs 5% in immunocompetent)<ref name="Biondo2016">Biondo S, et al. Diverticulitis in immunosuppressed patients: A fatal outcome requiring a new approach? Can J Surg. 2016;59(4):254-259. doi:10.1503/cjs.014915</ref>		*Higher risk of failure of non-operative management, higher emergency surgery rate, and significantly higher mortality (20% vs 5% in immunocompetent)<ref name="Biondo2016">Biondo S, et al. Diverticulitis in immunosuppressed patients: A fatal outcome requiring a new approach? Can J Surg. 2016;59(4):254-259. doi:10.1503/cjs.014915</ref>
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	*Emergent surgical consult		*Emergent surgical consult
	*Hemodynamically unstable or critically ill: ~~[[Special:MyLanguage/~~Hartmann procedure~~\|Hartmann procedure]]~~ recommended<ref name="WSES2020"/>		*Hemodynamically unstable or critically ill: Hartmann procedure recommended<ref name="WSES2020"/>
	*Stable patients without significant comorbidities: primary resection with anastomosis ± diverting stoma may be considered<ref name="WSES2020"/>		*Stable patients without significant comorbidities: primary resection with anastomosis ± diverting stoma may be considered<ref name="WSES2020"/>
	*Damage control surgery with staged laparotomy may be appropriate in select unstable patients<ref name="WSES2020"/>		*Damage control surgery with staged laparotomy may be appropriate in select unstable patients<ref name="WSES2020"/>