Diverticulitis

Diagnosis:
- CT is the primary modality by which diverticulitis is diagnosed.  Resoltion of LLQ pain after a course of abx does not constitute evidence for an episode of diverticulitis.
- Pts should eventually undergo colonoscopy to rule out malignant processes, most wait 6-8 weeks to prevent blowing out a microperforation.

- 70% of cases of uncomplicated diverticulitis will resolve with medical therapy alone.

Hinchey Classification - Diverticulitis

When originally described based on laparotomy findings.  Now it is applied to CT findings.

0: Diverticulosis, no evidence of inflammation

1: Pericolonic or mesenteric abscess

2: Contained pelvic abscess

3: Free purulent perforation

4: Free feculent perforation

Diverticulitis - Indications for Surgery

Strong Evidence for Surgery:
- Diffuse peritonitis
- Free perforation
- Fistula
- Stricture
- Obstruction
- Immunocompromised patient
- >= 4 uncomplicated episodes

Conflicting Evidence for Surgery:
- After abscess drainage
- Uncomplicated, 2 or 3 episodes

Surgery No Longer Supports Surgery:
- Uncomplicated 1st episode
- Age <50

Broderick-Villa G, 2005: Large retrospective review examining pts with recurrent diverticulitis.  After conservative treatment, few (13%) recurred and most of these recurrences were managed conservatively again.