Update on the management of sigmoid diverticulitis

Table 2 Workup for acute and chronic presentations of diverticulitis

	Acute	Chronic
History	Onset, progression, severity, location. Previous colon evaluation (< 2 yr). Previous episodes. Bowel habits	Recurrent attacks. Previous hospitalizations.Previous imaging. Previous colon evaluation (< 2 yr). Change in bowel habits
Physical examination	Localized vs diffuse peritonitis?	Abdominal distension. Fistula
Lab tests	WBC, CRP	Anemia? UTI?
Imaging	CT with oral/rectal and intravenous contrast: (1) Phlegmon; (2) Abscess/contrast extravasation; (3) Free air; and (4) Findings suggestive of other diagnosis	CT with oral/rectal and intravenous contrast: (1) Wall thickening; (2) Extraluminal contrast/air; (3) Fistulization; (4) Proximal colon distention; and (5) Rule out cancer features
Endoscopy	Avoid in acute phase, plan after 6 wk à rule out malignancy/IBD and/or synchronous pathology	Always à assess for mucosal pathology at target site and for synchronous pathology in the rest of the colon
Additional	(1) Possible CT-guided abscess drainage; and (2) Possible water-soluble contrast enema	(1) If colon evaluation incomplete à CT colonography or barium double contrast enema; and (2) Potentially cystoscopy, colposcopy

WBC: White blood cell; CRP: C-reactive protein; UTI: Urinary tract infection; CT: Computed tomography; IBD: Inflammatory bowel disease.