Clinical manifestations and diagnosis of acute diverticulitis in adults > 의학

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SUMMARY AND RECOMMENDATIONS

●Acute diverticulitis is defined as inflammation and/or infection of a diverticulum. (See 'Definitions' above.)

●The mean age at admission for acute diverticulitis is 63 years. While the incidence of acute diverticulitis is lower in younger individuals, approximately 16 percent of admissions for acute diverticulitis are in patients under 45 years of age.

●Abdominal pain is the most common complaint in patients with acute diverticulitis. The pain is left sided in approximately 85 percent of patients. However, patients may present with right lower quadrant or suprapubic pain due to the presence of a redundant inflamed sigmoid colon or right-sided (cecal) diverticulitis, which is more common in Asians. Patients may also have a low-grade fever. Other associated symptoms include nausea, vomiting, constipation, and diarrhea. (See 'Clinical features'above.)

●Approximately 25 percent of patients with acute diverticulitis have associated complications. Acute complications include bowel obstruction, development of an abscess, fistula, or a colonic perforation into the peritoneum and peritonitis. Recurrent attacks of diverticulitis or persistent chronic diverticular inflammation can result in the formation of a colonic stricture. (See 'Acute complications' above and 'Disease course' above.)

●The diagnosis of acute diverticulitis should be suspected in a patient with lower abdominal pain with tenderness to palpation on physical examination. Laboratory findings of leukocytosis, while not sensitive or specific for acute diverticulitis, can support the diagnosis. Abdominal imaging is required to establish the diagnosis of acute diverticulitis. We perform an abdominal computed tomography (CT) scan with oral and intravenous contrast to establish the diagnosis of acute diverticulitis because it has a high sensitivity and specificity for acute diverticulitis and can exclude other causes of abdominal pain.

CT scan findings suggestive of acute diverticulitis include the presence of localized bowel wall thickening (>4 mm), an increase in soft tissue density within the pericolonic fat secondary to inflammation, and the presence of colonic diverticula. (See 'Diagnosis' above and 'Computed tomography scan' above.)

●Colonoscopy has no role in establishing the diagnosis of acute diverticulitis and should not be performed in the acute setting due to the risk of perforation. However, a colonoscopy should generally be performed at least six weeks after recovery to definitively rule out the presence of an underlying colorectal cancer, unless the patient has had a colonoscopy within the previous year. (See 'Exclusion of an underlying malignancy' above.)

●Following conservative therapy for a first attack of acute diverticulitis, approximately 30 percent of patients will remain asymptomatic. However, approximately 20 to 40 percent of patients have recurrent bouts of diverticulitis and up to 20 percent of patients will continue to have chronic abdominal pain. In approximately 5 percent of patients, pain may be due to low grade or smoldering diverticulitis with persistent chronic diverticular inflammation. Recurrent attacks of diverticulitis or persistent chronic diverticular inflammation can result in the formation of a colonic stricture. (See 'Disease course' above.)

●In patients with acute diverticulitis, mortality rates vary depending on the presence of complications and patient comorbidities. (See 'Mortality' above.)