Summary
Definition
History and exam
Key diagnostic factors
- left lower quadrant abdominal pain
- fever
Other diagnostic factors
- guarding in left lower quadrant
- tenderness in left lower quadrant
- rebound tenderness
- diffuse abdominal tenderness
- change in bowel habit
- palpable abdominal mass
Risk factors
- age >50 years
- low dietary fiber
- diet rich in salt, meat, and sugar
- obesity (BMI >30)
- use of nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, or opioids
- tobacco smoking
- alcohol consumption
Investigações diagnósticas
Primeiras investigações a serem solicitadas
- CBC with differential
- CRP
- basic metabolic panel
- contrast CT scan of abdomen
Investigações a serem consideradas
- blood culture
- ABG and serum lactate
- noncontrast CT scan of abdomen
- abdominal ultrasound (graded-compression)
- abdominal MRI scan
- colonoscopy or sigmoidoscopy
- diagnostic laparoscopy/exploratory laparotomy
Algoritmo de tratamento
asymptomatic diverticulosis
acute uncomplicated diverticulitis
acute complicated diverticulitis
recurrent diverticulitis
Colaboradores
Autores
Marilyse Boutros, MD, FACS, FRCSC
Vice-Chair and Regional Director of Research for the Digestive Disease Institute, Cleveland Clinic Weston Hospital
Colorectal Surgeon, Cleveland Clinic Florida
Weston
FL
Clinical Affiliate Professor of Surgery, Florida Atlantic University
Boca Raton
FL
Professor of Surgery, McGill University
Montreal
Canada
Declarações
MB has received teaching honorarium from Ethicon and Johnson and Johnson.
Sameh Hany Emile, MBBCh, MSc, MD, FACS
Project Scientist
Department of Colorectal Surgery
Cleveland Clinic Florida
Weston
FL
Clinical Affiliate Associate Professor of Surgery
Florida Atlantic University
Boca Raton
FL
Associate Professor of Surgery
Mansoura University Faculty of Medicine
Mansoura City
Egypt
Declarações
SHE receives consultancy fees from Becton, Dickinson and Company.
Agradecimentos
Dr Marilyse Boutros and Dr Sameh Hany Emile would like to gratefully acknowledge Dr Mohamed A. Thaha, Dr Jayan D. Jayasinghe, Dr Emma Carrington, Ms Kathryn Lynes, Professor Norman S. Williams, and Dr Abbasi Akhtar, the previous contributors to this topic.
Declarações
MAT declares he has no competing interests. JDJ declares that he has no competing interests. EC has received honoraria for teaching, and acts as a consultant for Laborie Medical Management Systems. KL has received funding for a research fellowship from the David Johnston Fellowship through the Royal College of Surgeons of England. NSW is an author of a reference cited in this topic. AA declares that he has no competing interests.
Revisores
Ned Snyder, MD, FACP
Professor of Medicine
Chief of Clinical Gastroenterology and Hepatology
University of Texas Medical Branch
Galveston
TX
Declarações
NS declares that he has no competing interests.
Nicolas Regenet, MD
Clinic of digestive and endocrine surgery
University Hospital
Nantes
France
Declarações
NR declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
Referências
Principais artigos
Hall J, Hardiman K, Lee S, et al. The American Society of Colon and Rectal Surgeons clinical practice guidelines for the treatment of left-sided colonic diverticulitis. Dis Colon Rectum. 2020 Jun;63(6):728-47.Texto completo Resumo
Sartelli M, Weber DG, Kluger Y, et al. 2020 update of the WSES guidelines for the management of acute colonic diverticulitis in the emergency setting. World J Emerg Surg. 2020 May 7;15(1):32.Texto completo Resumo
Stollman N, Smalley W, Hirano I; AGA Institute Clinical Guidelines Committee. American Gastroenterological Association Institute guideline on the management of acute diverticulitis. Gastroenterology. 2015 Dec;149(7):1944-9.Texto completo Resumo
Peery AF, Shaukat A, Strate LL. AGA clinical practice update on medical management of colonic diverticulitis: expert review. Gastroenterology. 2021 Feb;160(3):906-11.e1.Texto completo Resumo
American College of Radiology. ACR appropriateness criteria: left lower quadrant pain. 2023 [internet publication].Texto completo
Qaseem A, Etxeandia-Ikobaltzeta I, Lin JS, et al; Clinical Guidelines Committee of the American College of Physicians. Diagnosis and management of acute left-sided colonic diverticulitis: a clinical guideline from the American College of Physicians. Ann Intern Med. 2022 Mar;175(3):399-415.Texto completo Resumo
Artigos de referência
Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
Diagnósticos diferenciais
- Endometriosis
- Colorectal cancer
- Appendicitis
Mais Diagnósticos diferenciaisDiretrizes
- Diagnosis and management of acute left-sided colonic diverticulitis
- 2020 update of the WSES guidelines for the management of acute colonic diverticulitis in the emergency setting
Mais DiretrizesFolhetos informativos para os pacientes
Appendicitis
Constipation in adults
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