Acute Diverticulitis Updates
Question: What’s new with diverticulitis in the ED?
Source: Long, B., Werner, J., & Gottlieb, M. (2024). Emergency medicine updates: Acute diverticulitis. The American journal of emergency medicine, 76, 1–6. [pubmed]
Some notable takeaways:
Labs
Patient's will have leukocytosis in only 50% of cases.
Interestingly, guidelines do recommend CRP—given there is some data that a higher CRP is associated with a higher risk of complications. The threshold may be ~17 mg/dL depending on the study with close to 90% sensitivity.
Imaging
Society Guidelines from multiple surgical organizations still recommend CT with IV contrast (Sorry ultrasound) and recommend against using clinical diagnosis alone.
Patients who present with symptoms similar to a prior episode of diverticulitis and who are well-appearing with no peritoneal signs, can tolerate oral intake, are not immunocompromised, and can follow-up may not require CT imaging in the ED setting according to the American College of Radiology.
Treatment
Acute uncomplicated diverticulitis does NOT necessarily require antibiotics based on multiple high quality RCTs. In general, it would be reasonable to avoid antibiotics in those who are hemodynamically stable; can tolerate oral intake; have no severe comorbidities (liver disease, end-stage renal disease, uncontrolled diabetes, immunocompromised status); and have no evidence of sepsis, obstruction, perforation, or abscess.
Complicated Diverticulitis requires surgical consultation and IV abx
Discharge Criteria
Patients with uncomplicated diverticulitis who have their symptoms controlled in the ED and are able to tolerate oral intake, have normal vital signs, no significant immunosuppression, and no complications. These need prompt followup to ensure resolution.
See below screenshot from UptoDate for Indications to pursue admission.
Best,
Dillon
