Acute diverticulitis

Acute diverticulitis is a condition where small, bulging pouches (diverticula) in the digestive tract become inflamed or infected. The presence of these pouches is called diverticulosis, which is very common, especially in older adults. Diverticulitis develops when one or more of these pouches become inflamed and cause symptoms. 

Signs and symptoms

The signs and symptoms of acute diverticulitis often appear suddenly and can range in severity. 

Key symptoms include:

  • Abdominal pain: This is the most common symptom, typically located in the lower left side of the abdomen. The pain may be constant, last for several days, and increase in intensity.

  • Fever and chills: An infection can lead to a fever, which may be accompanied by chills.

  • Changes in bowel habits: This can include sudden constipation or, less commonly, diarrhea.

  • Nausea and vomiting: These symptoms may occur, especially with more severe inflammation.

  • Bloating and gas: Many people experience an increase in bloating and gas during a flare-up.

  • Abdominal tenderness: The affected area of the abdomen may feel tender to the touch. 

When to seek immediate medical attention:

It is important to go to the hospital if you experience severe abdominal pain, a fever of 102°F or higher, a hard and tense abdomen, or bloody stools, as this could indicate a complication. 

Diagnosis

Because symptoms can mimic other digestive issues, a doctor will often need to confirm a diagnosis of acute diverticulitis to rule out other potential causes. 

  • Physical exam: Your doctor will perform a physical exam, paying attention to any abdominal tenderness, particularly in the lower left side.

  • Blood tests: A blood test can reveal an increase in inflammatory markers or white blood cell count, which suggests an infection.

  • CT scan: This is the most effective and commonly used imaging test. It provides a detailed view of the colon to confirm the diagnosis and check for complications like abscesses or perforations.

  • Colonoscopy: While not used during an acute attack due to the risk of perforation, a colonoscopy may be recommended four to six weeks after symptoms have resolved to examine the colon and rule out other issues. 

Treatment

The treatment for acute diverticulitis depends on the severity of the symptoms. 

Mild, uncomplicated diverticulitis

In many cases, mild diverticulitis can be treated at home. 

  • Clear liquid diet: A doctor may recommend a few days of a clear liquid diet to give the colon a rest. This includes water, broth, and clear juices.

  • Reintroducing low-fiber foods: As symptoms improve, you can gradually reintroduce low-fiber foods like eggs, white rice, and pasta.

  • Pain relief: Over-the-counter pain relievers like acetaminophen (Tylenol) may be recommended, but nonsteroidal anti-inflammatory drugs (NSAIDs) should be avoided as they can increase the risk of complications.

  • Antibiotics: In some mild cases, your doctor may not prescribe antibiotics. If an infection is suspected, oral antibiotics may be used. 

Severe or complicated diverticulitis

If your symptoms are severe or if complications arise, a hospital stay may be necessary. 

  • Intravenous (IV) fluids and antibiotics: In the hospital, you may receive antibiotics and fluids directly into your vein.

  • Drainage of abscesses: A large abscess (a pus-filled pocket) may need to be drained using a needle guided by a CT scan.

  • Surgery: If complications such as a perforation (a hole in the colon), a fistula (an abnormal connection between organs), or a blockage occur, surgery may be necessary to remove the affected part of the colon

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