Management of acute colonic diverticulitis

* Criteria for inpatient management (only need to meet one):

• Complicated diverticulitis (refer to the ¶ footnote below)
• Sepsis or systemic inflammatory response syndrome (SIRS) evidenced by more than one of the following: Temperature >38° or <36° Celsius, heart rate >90 beats per minute (bpm), respiration rate >20 respirations per minute (rpm), white blood cell count >12,000/mL or <4000/mL, C-reactive protein >15 mg/dL
• Severe abdominal pain or diffuse peritonitis, and/or failure to reduce abdominal pain in the emergency department to <5 on a visual analog scale (VAS)
• Microperforation (eg, a few air bubbles outside of the colon without contrast extravasation or phlegmon)
• Age >70 years
• Significant comorbidities (eg, diabetes mellitus with organic involvement [eg, retinopathy, angiopathy, nephropathy], a recent cardiogenic event [eg, acute myocardial infarction, angina, heart failure], or recent decompensation of chronic liver disease [≥Child B] or end-stage renal disease)
• Immunosuppression (eg, poorly controlled diabetes mellitus, chronic high-dose corticosteroid use, use of other immunosuppressive agents, advanced human immunodeficiency virus [HIV] infection or acquired immunodeficiency syndrome [AIDS], B or T cell leukocyte deficiency, active cancer of hematologic malignancy, or organ transplant)
• Intolerance of oral intake secondary to bowel obstruction or ileus
• Noncompliance with care/unreliability for return visits/lack of support system
• Failure of outpatient treatment

¶ Complications of acute diverticulitis:

• Frank perforation
• Abscess (asymptomatic patients with a healed diverticular abscess may not need surgery due to a lower risk of complicated recurrence)
• Obstruction
• Fistulization

Δ Criteria for discharge (all must be met):

• Normalization of vital signs
• Resolution of severe abdominal pain
• Resolution of significant leukocytosis
• Tolerance of oral diet