Summary
Definition
History and exam
Key diagnostic factors
- presença de fatores de risco
- dor abdominal no quadrante inferior esquerdo
- febre
Other diagnostic factors
- defesa no quadrante inferior esquerdo
- sensibilidade no quadrante inferior esquerdo
- dor à descompressão brusca
- desconforto abdominal difuso
- alteração no hábito intestinal
- massa abdominal palpável
Risk factors
- idade >50 anos
- dieta pobre em fibras
- dieta rica em sal, carne e açúcar
- obesidade (índice de massa corporal [IMC] >30)
- uso de anti-inflamatórios não esteroidais (AINEs), corticosteroides ou opioides
- tabagismo
- consumo de bebidas alcoólicas
Diagnostic tests
1st tests to order
- Hemograma completo com diferencial
- proteína C-reativa
- perfil metabólico básico
- tomografia computadorizada (TC) com contraste do abdome
Tests to consider
- hemocultura
- Gasometria arterial e lactato sérico
- TC sem contraste do abdome
- ultrassonografia abdominal (compressão graduada)
- ressonância nuclear magnética (RNM) abdominal
- colonoscopia ou sigmoidoscopia
- laparoscopia diagnóstica/laparotomia exploratória
Treatment algorithm
diverticulose assintomática
diverticulite aguda não complicada
diverticulite aguda complicada
diverticulite recorrente
Contributors
Authors
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
Disclosures
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
Disclosures
SHE receives consultancy fees from Becton, Dickinson and Company.
Acknowledgements
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.
Disclosures
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.
Peer reviewers
Ned Snyder, MD, FACP
Professor of Medicine
Chief of Clinical Gastroenterology and Hepatology
University of Texas Medical Branch
Galveston
TX
Disclosures
NS declares that he has no competing interests.
Nicolas Regenet, MD
Clinic of digestive and endocrine surgery
University Hospital
Nantes
France
Disclosures
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.
References
Key articles
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.Full text Abstract
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.Full text Abstract
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.Full text Abstract
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.Full text Abstract
American College of Radiology. ACR appropriateness criteria: left lower quadrant pain. 2023 [internet publication].Full text
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.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Endometriose
- Câncer colorretal
- Apendicite
More DifferentialsGuidelines
- 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
More GuidelinesPatient information
Apendicite
Constipação em adultos
More Patient information
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