Herniations or saclike protrusions of the mucosa through the muscularis at points of nutrient artery penetration; possibly due to increased intraluminal pressure, low-fiber diet; most common in sigmoid colon.
TREATMENT | ||
Diverticular DiseasePAINHigh-fiber diet, psyllium extract (e.g., Metamucil 1 tbsp PO qd or bid), anticholinergics (e.g., dicyclomine HCl 10-40 mg PO qid). DIVERTICULITISNPO, IV fluids, antibiotics for 7-10 d (e.g., trimethoprim/sulfamethoxazole or ciprofloxacin and metronidazole; add ampicillin to cover enterococci in nonresponders); for ambulatory pts, ampicillin/clavulanate (clear liquid diet); surgical resection in refractory or frequently recurrent cases, young persons (age <50), immunosuppressed pts, or when there is inability to exclude cancer. Pts who have had at least two documented episodes and those who respond slowly to medical therapy should be offered surgical options to achieve removal of the diseased colonic segment, controlling sepsis, eliminating obstructions or fistulas, and restoring intestinal continuity. |