Virtually everyone over 50 has diverticulosis — little pockets called diverticula that form in the large intestine. If one gets infected with normal bacteria in the bowel (diverticulitis), it causes pain. This mostly occurs on the lower left side of the abdomen; in Asia (especially Japan), it’s much more common on the right. Diverticula used to only develop in older people, but the younger get them too now due to our low-fiber diets.
Aside from pain, there may be constipation, less commonly mild diarrhea. There may be a mild fever. And there’s always tenderness — it hurts when we press in the area.
We usually order a CT scan on such patients, which confirms the diagnosis. It also rules out other possible conditions (tumors, etc.), which are more common in older persons than younger. It’s usually easiest to obtain the CT in an ER, but not necessary if it can be arranged in 1-2 days at the most.
Treatment for uncomplicated diverticulitis is with oral antibiotics, although recent studies suggest they may not be necessary. It could get better on its own, but there would be a risk for it to keep recurring. If the patient isn’t getting better in 2-3 days, we admit them for IV therapy, to be sure to prevent complications.
Complicated diverticulitis is when there’s an abscess, or the bowel gets obstructed, or perforates. Such patients are a lot sicker, with higher fevers and very tender abdomens. They get admitted to the hospital for IV antibiotics, and sometimes surgery.