ASGE Annual GI Advanced Practice Provider Course (On-demand) (Day One) | March 2026-Approach to Care for Patients with Diverticulitis

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This document outlines a clinical approach to patients with diverticulitis, covering epidemiology, presentation, evaluation, treatment, and criteria for hospital admission. Diverticulosis is common and increases with age (about 20% by age 40 and 40–60% by age 60), tends to be progressive, and most often affects the left colon—especially the sigmoid. Diverticulitis is increasingly seen in younger patients (under ~50). In a colonoscopy screening study, 42% had diverticulosis, with most diverticula located in the sigmoid colon.<br /><br />Risk factors highlighted include older age (≥60), male sex, smoking, elevated BMI, and White race. The pathophysiology is not fully defined, but diverticula form at weak points in the colonic muscle where mucosa/submucosa herniate; abnormal colonic motility may contribute.<br /><br />Clinical manifestations depend on location and severity but classically include sudden, constant left lower quadrant abdominal pain with tenderness and fever. Acute complications include obstruction, abscess, perforation, and fistula. Differential diagnosis is broad and includes IBS, colorectal cancer, appendicitis, IBD, infectious/ischemic colitis, gynecologic infection (tubo-ovarian abscess), cystitis, and kidney stones.<br /><br />Recommended diagnostic work-up includes CBC, CMP, and CT abdomen/pelvis with contrast to distinguish uncomplicated from complicated disease. Uncomplicated diverticulitis may be managed without oral antibiotics (per recent literature), focusing on pain control and reassessment in about a week; if improved, colonoscopy is recommended in 6–8 weeks if not done within the last year. Complicated disease (e.g., abscess ≥4 cm) may require percutaneous drainage or inpatient care with IV antibiotics, IV analgesia, and bowel rest (NPO or liquids).<br /><br />Outpatient antibiotic options are listed (e.g., amoxicillin-clavulanate or fluoroquinolone plus metronidazole), typically 4–7 days for immunocompetent patients and 10–14 days for immunosuppressed patients.<br /><br />Indications for hospitalization include complicated diverticulitis, sepsis, severe pain, microperforation, age ≥70, significant comorbidities, immunosuppression, inability to tolerate oral intake, unreliable follow-up/nonadherence, and failure of outpatient treatment. Follow-up emphasizes documenting improvement, tailoring reassessment to comorbidities, and providing education and anticipatory guidance, including lifestyle and dietary recommendations (higher fiber, reduced red meat, tobacco cessation; evidence around nuts/seeds is unproven; caution with NSAIDs/aspirin).

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Jill Olmstead, DNP, ANP-BC, FAANP

Keywords

diverticulitis clinical management

diverticulosis epidemiology age-related prevalence

left lower quadrant abdominal pain fever

sigmoid colon diverticula

risk factors smoking BMI male White race

CT abdomen pelvis with contrast

uncomplicated vs complicated diverticulitis

outpatient antibiotics amoxicillin-clavulanate fluoroquinolone metronidazole

hospital admission criteria sepsis microperforation immunosuppression

complications abscess perforation fistula obstruction