In this episode, we review diverticular disease, including the progression from diverticulosis to acute diverticulitis. We break down the pathophysiology of mucosal outpouchings in high-pressure zones of the sigmoid colon and how obstruction can lead to inflammation, abscess, perforation, or peritonitis. The discussion highlights classic left lower quadrant pain, the role of CT imaging for diagnosis and staging, and evidence-based management ranging from outpatient antibiotics to percutaneous drainage or surgical intervention. We also address prevention strategies, common complications such as fistula formation, and key clinical pearls to guide decision-making in both uncomplicated and complicated cases.

References

1) Bushardt RL, Colomb-Lippa DM, Klinger AM, Reed H. The JAAPA QRS Review for PAs: Study Plan and Guide for PANCE and PANRE. 1st ed. LWW; 2021. ISBN: 9781975143817.

2) Tochigi T, Kosugi C, Shuto K, Mori M, Hirano A, Koda K. Management of complicated diverticulitis of the colon. Ann Gastroenterol Surg. 2017 Sep 28;2(1):22-27. doi: 10.1002/ags3.12035. PMID: 29863123; PMCID: PMC5868871.

3) Horesh N, Emile S, Wexner SD. Diverticular disease. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 22nd ed. Elsevier