Management of Diverticular Disease

Suzanne Albrecht, PharmD, MSLIS

Disclosures

US Pharmacist 

In This Article

Diagnosis

Diverticulitis can mimic many other pathologies. These include acute appendicitis, colorectal cancer, complicated ulcer disease, Crohn's disease, cystitis, ectopic pregnancy, gallbladder disease, incarcerated hernia, ischemic colitis, mesenteric infarction, pancreatic disease, pelvic inflammatory disease, pseudomembranous colitis, renal disease, small bowel obstruction, UTI, ulcerative colitis, and ovarian cyst, abscess, neoplasm, or torsion.[4,6,9,10] The European Association of Endoscopic Surgeons (EAES) has devised a classification system to aid in diagnostic testing, which is outlined in Table 1 .[3] A CT scan with the use of oral, IV, or rectal contrast is a very beneficial examination method, because it is highly sensitive and specific. It is associated with a low falsepositive rate.[6]

A CT scan can determine whether hospitalization is warranted.[3,6] It can also help determine the risk of secondary complications if medication therapy on an outpatient basis is opted for instead of surgery.[6] The findings on a CT scan that suggest diverticulitis include the presence of diverticula and wall thickening (>4 mm, which is called mychosis), pericolic fat infiltration, abscess formation, and extraluminal air or contrast fluid collection.[3,7,9,10] Colonoscopy and barium enema are contraindicated during an acute attack of diverticulitis because of the increased risk of perforation.[9] After the resolution of an acute episode, a colonoscopy or barium enema should be done at about 6 weeks to rule out carcinoma or IBD.[9]

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