Acute Diverticulitis in Adults - Primary Care

Publication: 13/12/2011  --
Last review: 19/09/2017  
Next review: 19/09/2020  
Clinical Guideline
CURRENT 
ID: 2805 
Approved By: LAPC 
Copyright© Leeds Teaching Hospitals NHS Trust 2017  

 

This Clinical Guideline is intended for use by healthcare professionals within Leeds unless otherwise stated.
For healthcare professionals in other trusts, please ensure that you consult relevant local and national guidance.

Acute Diverticulitis in Primary Care

Approximately 4% patients with diverticulosis develop acute diverticulitis. Diverticulitis classically presents with constant abdominal pain (usually left lower quadrant) and is often associated with fevers/chills, shivering/sweating, nausea, vomiting, constipation or diarrhoea.
Acute diverticulitis is classified as complicated or uncomplicated. Physical examination may be sufficient to exclude complicated diverticulitis:

  • Complicated diverticulitis: defined as acute diverticulitis accompanied by abscess, fistula, bowel obstruction, or free intra-abdominal perforation. These complications are normally confirmed radiologically but may be suspected clinically e.g. peritonism.
  • Uncomplicated diverticulitis: defined as diverticulitis without evidence of complications as listed above.

Assess if the patient has Systemic Inflammatory Response Syndrome (SIRS).

SIRS= ≥2 of: Body temperature < 36 °C or > 38 °C , Heart rate > 90 bpm, respiratory rate > 20 breaths per minute or, on blood gas, a PaCO2 less than 32 mm Hg (4.3 kPa) White blood cell count < 4 × 109 or > 12 × 109 cells/L.
Uncomplicated diverticulitis: consider admission for patients who are elderly, unable to take oral fluids, have significant co-morbidities or who have evidence of a systemic inflammatory response (SIRS).
Complicated diverticulitis: admission indicated.

 

Preferred
Option

Alternative
Option

Notes

Acute Uncomplicated Diverticulitis
(without SIRS)

Antibiotics are not normally indicated (Chabok et. al. 2012)
Treat with Analgesia and Hydration

Monitor patients closely for evidence of complications or deterioration.

Acute Uncomplicated Diverticulitis
(with SIRS/Sepsis)

Referral to secondary care

 

Acute Complicated Diverticulitis

Referral to secondary care

 

Chabok et. al (2012) RCT of Antibiotics in acute uncomplicated diverticulitis Br J Surg,99:532-539

Provenance

Record: 2805
Objective:
Clinical condition:

Acute Diverticulitis in Adults

Target patient group: Adults
Target professional group(s): Primary Care Doctors
Pharmacists
Primary Care Nurses
Secondary Care Doctors
Secondary Care Nurses
Adapted from:

Evidence base

Chabok et. al (2012) RCT of Antibiotics in acute uncomplicated diverticulitis Br J Surg,99:532-539

Approved By

LAPC

Document history

LHP version 1.0

Related information

Not supplied