What are the possible complications of diverticulitis?

Updated: Aug 06, 2019
  • Author: Elie M Ghoulam, MD, MS; Chief Editor: BS Anand, MD  more...
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Complications of diverticulitis may be more severe in immunocompromised patients (those infected with human immunodeficiency virus (HIV), organ transplant recipients, those on long-term corticosteroids). These patients are more likely to have perforation. [27]

Complications of diverticulitis include the following:

  • Abscess: Most common complication of diverticulitis

  • Intestinal fistula, perforation, or obstruction

  • Generalized peritonitis

  • Sepsis

  • Stricture disease


Abscesses amenable to percutaneous drainage are larger than 4 cm. [28] Abscesses not amenable to percutaneous drainage are either too small (< 3 cm) or they are adjacent to important structures. [28] Patients who do not improve within 24 to 48 hours after drainage should be referred for surgery.

Patients with abscesses successfully treated with antibiotics or are percutaneously drained should also be referred for elective surgery because of a high rate of recurrence in this population. [27]


Frank perforation is diagnosed by the presence of free air under the diaphragm, with or without extravasation of contrast medium or fluid, which can be complicated with life-threatening diffuse peritonitis.

Microperforation (or contained perforation) is only evident by the presence of air bubbles outside of the bowel wall on computed tomography (CT) imaging.


Surgical resection of the involved bowel segment is mandatory to rule out cancer.


Diverticular fistulas rarely close spontaneously, and a resection of the affected bowel segment is generally required.

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