Diverticulitis
Diverticulitis
Acute uncomplicated diverticulitis on CT ***
Hemodynamically stable patients with radiographically confirmed diverticulitis, in need of additional IV fluids, anti-emetics, antibiotics, or analgesics.
Must be cleared by general surgery, IF surgery was consulted initially
*** Diverticulitis with small (< 3cm) abscess formation MAY go to CDU after Surgical Consultation in the Main ED has determined that surgical intervention or drainage is not necessary.
Clinical signs of peritonitis
Age > 80 years old
Cannot tolerate clear liquid diet
Already failed outpatient treatment
Persistent abnormal vital signs (SIRS) after ED treatment
Severe electrolyte abnormalities
Immunocompromised
History of Crohn’s disease or ulcerative colitis
Acute on chronic renal dysfunction
Most patients who are sufficiently symptomatic from Diverticulitis to warrant a CDU admission should be treated with Antibiotics.
For select patients with only minimal symptoms and uncomplicated diverticulitis, a No Antibiotics approach is also reasonable.
Otherwise pain control, relative bowel rest and IV fluids are the interventions in CDU
Antibiotics - Recommended Regimens
Piperacillin - Tazobactam OR Ampicillin Sulbactam
Cephalosporin (Ceftriaxone, Cefuroxime, Cephazolin) plus Metronidazole
Levofloxacin + Metronidazole
Nutrition
Initially Clear Liquid Diet with Nursing order to Advance Diet as Tolerated
IV fluids
LR or NS @ 75 cc / hr
Pain Control
Encourage initial use of ALTO options, APAP (IV or PO), Ketorolac/Ibuprofen
Breakthrough pain control with oral opiates (e.g. Oxycodone 5 mg-10mg Q4h PRN)
Disposition
No development of peritonitis
Resolution of fever or abnormal vital signs
Tolerating po intake
Pain controlled with po medications
At time of discharge a 5 day course of antibiotics is generally sufficient
Worsening abdominal pain or distention
Inability to tolerate oral diet
Increasing tenderness on abdominal exam
Development of peritoneal signs, such as rebound or guarding
Persistent fever, tachycardia, and/or development of hypotension
Worsening laboratory values, such as leukocytosis, acidosis, lactate