Diverticular disease

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups: see disclaimer

ACUTE

asymptomatic diverticulosis

1st line – dietary and lifestyle modifications

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1st line –

dietary and lifestyle modifications

Diverticulosis is the presence of diverticula without symptoms.[39]

Asymptomatic diverticulosis discovered incidentally requires no treatment, although bulk-forming laxatives may be considered for patients with constipation.[39]

There is evidence to suggest that these patients might benefit from increasing dietary fibre, including fruit and vegetables.[43][44][66]

Advise a healthy balanced diet.[39] In patients with a low-fibre diet and constipation, advise increasing fibre intake gradually to minimise flatulence and bloating, and advise adequate fluid consumption.[39]

Practical tip

There is no need for people with diverticulosis to avoid seeds, nuts, popcorn, or fruit skin.[39]

Explain the benefits of exercise, weight loss, and smoking cessation, when needed, to help reduce the risk of developing acute diverticulitis or symptomatic disease.[25][39]

symptomatic diverticular disease

1st line – dietary and lifestyle modifications

Back

1st line –

dietary and lifestyle modifications

Diverticular disease may be defined as the presence of diverticula with mild abdominal pain or tenderness and no systemic symptoms.[39]

Give dietary and lifestyle advice to patients as for asymptomatic diverticulosis (see above).

For patients with mild symptoms of diverticular disease advise lifelong (if tolerated) dietary modification, especially gradually increasing the fibre content over weeks and increasing hydration.[39][66][67]
- There is weak evidence to suggest that these patients might benefit from increasing dietary fibre, including fruit and vegetables.[43][44][66]
There is no need for patients to avoid seeds, nuts, popcorn, or fruit skin.[39]
In patients with a low-fibre diet and constipation, advise increasing fibre intake gradually to minimise flatulence and bloating, and advise adequate fluid consumption.[39]

Consider bulk-forming laxatives if a high-fibre diet is not tolerated or the patient has persistent constipation or diarrhoea.[39]

Consider alternative causes in a patient with persistent symptoms that do not respond to treatment.[39]

Consider – analgesia

Consider – antispasmodic

acute diverticulitis (uncomplicated)

1st line – analgesia

Consider – antispasmodic

Consider – oral antibiotic

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Consider –

oral antibiotic

Additional treatment recommended for SOME patients in selected patient group

Offer oral antibiotics to a patient with uncomplicated acute diverticulitis who is systemically unwell, has signs of systemic inflammation, is immunosuppressed, or has significant comorbidities.[39]

If the patient is systemically well, consider not prescribing antibiotics.[39] Instead offer analgesia (see above) and advise to return if symptoms worsen.[39]

Follow your local protocol or take advice from microbiology. In the UK, the National Institute for Health and Care Excellence recommends a 5-day course of the following antibiotics:

Amoxicillin/clavulanate as the first-line choice
Or, if amoxicillin/clavulanate is unsuitable or the patient has penicillin allergy:
- Cefalexin (use caution in patients with a penicillin allergy) plus metronidazole; or
- Trimethoprim plus metronidazole; or
- Ciprofloxacin (only if switching from intravenous ciprofloxacin with specialist advice; consider safety issues - see below) plus metronidazole.

Systemic fluoroquinolone antibiotics, such as ciprofloxacin, may cause serious, disabling, and potentially long-lasting or irreversible adverse events. This includes, but is not limited to: tendinopathy/tendon rupture; peripheral neuropathy; arthropathy/arthralgia; aortic aneurysm and dissection; heart valve regurgitation; dysglycaemia; and central nervous system effects including seizures, depression, psychosis, and suicidal thoughts and behaviour.[68]

Prescribing restrictions apply to the use of fluoroquinolones, and these restrictions may vary between countries. In general, fluoroquinolones should be restricted for use in serious, life-threatening bacterial infections only. Some regulatory agencies may also recommend that they must only be used in situations where other antibiotics, that are commonly recommended for the infection, are inappropriate (e.g., resistance, contraindications, treatment failure, unavailability).
Consult your local guidelines and drug formulary for more information on suitability, contraindications, and precautions.

Patients with abdominal pain, fever, or leukocytosis who have been offered oral antibiotics can be safely treated at home, provided the computed tomography scan rules out any complications.[63][64]

If fever and leukocytosis persist after 72 hours or symptoms of acute diverticulitis or acute abdomen present, the patient should be admitted to hospital and given intravenous antibiotics used until clinical improvement - see Acute diverticulitis (complicated) patient group below.[65]

More info: Antibiotics in uncomplicated diverticulitis

Some investigators have questioned whether antibiotics are required in uncomplicated diverticulitis, proposing that diverticulitis may be an inflammatory rather than an infectious condition.

Meta-analyses of studies comparing antibiotics with no antibiotic treatment found that treating and monitoring uncomplicated diverticulitis without or with antibiotics is safe and effective and that observational management was not statistically different from antibiotic treatment for the primary outcome of needing surgery.[69][70][71][72][73][74]

One systematic review of studies comparing antibiotics with no antibiotics in patients with uncomplicated diverticulitis found no difference in risks for treatment failure, elective surgery, recurrence, and post-treatment complications.[75] Results of a subsequent Cochrane review, based on limited data from five randomised clinical trials, suggested that the effect of antibiotics for uncomplicated diverticulitis is uncertain for complications (early and long-term), emergency surgery, recurrence, and elective colonic resections.[76] [ ]

Guidelines from the UK National Institute for Health and Care Excellence (NICE), the World Society of Emergency Surgery (WSES), the American Gastroenterological Association (AGA), the American Society of Colon and Rectal Surgeons (ASCRS), and the American College of Physicians (ACP) recommend that antibiotics should be used selectively, rather than routinely, in patients with acute uncomplicated diverticulitis who are systemically well and otherwise healthy.[6][12][35][39][77]

Treatment course: 5 days then review.

Primary options

amoxicillin/clavulanate: 500/125 mg orally three times daily

Secondary options

cefalexin: 500 mg orally two to three times daily, may increase to 1000-1500 mg three to four times daily in severe infections

and

metronidazole: 400 mg orally three times daily

trimethoprim: 200 mg orally twice daily

and

metronidazole: 400 mg orally three times daily

Tertiary options

ciprofloxacin: 500 mg orally twice daily

and

metronidazole: 400 mg orally three times daily

Plus – low-residue diet

acute diverticulitis (complicated)

with acute rectal bleeding

1st line – stratify as stable or unstable and manage bleeding

Back

1st line –

stratify as stable or unstable and manage bleeding

The British Society of Gastroenterology guideline on the diagnosis and management of acute lower gastrointestinal bleeding recommends stratifying patients using the ‘shock index’ (the ratio of heart rate/systolic blood pressure), which is a marker of active bleeding.[56]

Stratify patients presenting with lower gastrointestinal bleeding as stable (shock index <1) or unstable (shock index >1). Stable bleeds can then be further categorised as major or minor using a risk assessment tool, such as the Oakland score.[56][78][79]

For haemodynamically unstable patients or those with a shock index of >1 after initial resuscitation, use computed tomographic (CT) angiography to locate the site of blood loss, prior to endoscopic or radiological therapy.[56]
- If no source of bleeding is located, use upper gastrointestinal endoscopy to see if the bleeding is from an upper gastrointestinal source.
- When catheter angiography is indicated, perform it as soon as possible after CT angiography.[56]
- Isotope-labelled red blood cell nuclear scan is another option, but is rarely used in this context and should be discussed with radiology.
Admit stable patients with a major bleed to hospital for colonoscopy to identify and treat the lesion.[56]
- Colonoscopy can be used for accurate diagnosis, and endoscopic haemostasis can be achieved for the majority of patients. This significantly reduces the need for surgery; however, its value in prevention of subsequent bleeding is unclear.[58][80][81]
- Endoscopic options for managing diverticular bleeding include injection or thermal therapies, endoscopic band ligation, or haemostatic powders.[56]

Consider surgery only if significant bleeding continues despite attempted endoscopic and angiographic haemostasis.[56]

Patients may be stable but require red blood cell transfusion.[56]

For patients on warfarin, stop warfarin at presentation. It can be restarted at 7 days after haemorrhage in patients with low thrombotic risk.[56]

In patients with unstable haemorrhage, reverse anticoagulation with prothrombin complex concentrate and vitamin K.[56]

Plus – supportive therapy

Plus – intravenous antibiotic

Back

Plus –

intravenous antibiotic

Treatment recommended for ALL patients in selected patient group

Give intravenous antibiotics to patients admitted to secondary care with suspected complicated diverticulitis.[39]

Review intravenous antibiotics within 48 hours, or after the computed tomographic scan if sooner, and consider stepping down to oral antibiotics.[39]

Follow your local protocol or take advice from microbiology. In the UK, the National Institute for Health and Care Excellence recommends for suspected or confirmed complicated diverticulitis the following intravenous antibiotics:[39]

Amoxicillin/clavulanate
Cefuroxime plus metronidazole
Amoxicillin plus gentamicin and metronidazole
Ciprofloxacin (only in people with allergy to penicillins and cephalosporins; consider safety issues - see below) plus metronidazole

Consult microbiology if alternative intravenous antibiotics are required.[39]

Prescribing restrictions apply to the use of fluoroquinolones, and these restrictions may vary between countries. In general, fluoroquinolones should be restricted for use in serious, life-threatening bacterial infections only. Some regulatory agencies may also recommend that they must only be used in situations where other antibiotics, that are commonly recommended for the infection, are inappropriate (e.g., resistance, contraindications, treatment failure, unavailability).
Consult your local guidelines and drug formulary for more information on suitability, contraindications, and precautions.

Consider any indications of sepsis in patients with complicated diverticulitis. See Sepsis in adults.

Practical tip

Sepsis

Think ‘Could this be sepsis?’ based on acute deterioration in a patient in whom there is clinical evidence or strong suspicion of infection.[45][46][47]

Arrange urgent review by a senior clinical decision-maker (e.g., ST3 level doctor in the UK) if you suspect sepsis:[45][51]

Within 30 minutes for a patient who is critically ill (e.g., NEWS2 score of 7 or more, evidence of septic shock, or other significant clinical concerns)
- A patient is also at high risk of severe illness or death from sepsis if they have a NEWS2 score below 7 and a single parameter contributes 3 points to their NEWS2 score and a medical review has confirmed that they are at high risk.
Within 1 hour for a patient who is severely ill (e.g., NEWS2 score of 5 or 6) or within 1 hour of any intervention for suspected sepsis (antibiotics/fluid resuscitation/oxygen) if there is no improvement in the patient’s condition.

Follow your local protocol for investigation and treatment of all patients with suspected sepsis, or those at risk. Start treatment promptly. Determine urgency of treatment according to likelihood of infection and severity of illness, or according to your local protocol.[50][51]

In the community or custodial settings: refer for emergency medical care in hospital (usually by blue-light ambulance in the UK) any patient who is acutely ill with a suspected infection and is:[45]

Deemed to be at high risk of deterioration due to organ dysfunction (as measured by risk stratification)
At risk of neutropenic sepsis.

Treatment course: a 7- to 10-day course of antibiotics is often recommended on the premise that there is background acute inflammation/infection accounting for the bleeding.

Primary options

amoxicillin/clavulanate: 1.2 g intravenously every 8 hours

cefuroxime: 750 mg intravenously every 6-8 hours, may increase to 1500 mg every 6-8 hours in severe infections

and

metronidazole: 500 mg intravenously every 8 hours

amoxicillin: 500 mg intravenously every 8 hours, may increase to 1000 mg every 6 hours in severe infections

and

gentamicin: 5-7 mg/kg intravenously every 24 hours

and

metronidazole: 500 mg intravenously every 8 hours

Secondary options

ciprofloxacin: 400 mg intravenously every 8-12 hours

and

metronidazole: 500 mg intravenously every 8 hours

Plus – analgesia

Back

Plus –

analgesia

Treatment recommended for ALL patients in selected patient group

Use a simple analgesic such as paracetamol. In general, analgesics that cause constipation (such as opioids) should be avoided. However, for relief of severe pain, analgesia can be escalated using tramadol and, if necessary, an opioid (e.g., morphine) in a titrated fashion.

Primary options

paracetamol: oral: 500-1000 mg orally every 4-6 hours when required, maximum 4000 mg/day; intravenous (<51 kg body weight): 15 mg/kg intravenously every 4-6 hours when required, maximum 60 mg/kg/day; intravenous (≥51 kg body weight): 1000 mg intravenously every 4-6 hours when required, maximum 4000 mg/day (3000 mg/day if risk factors for hepatotoxicity)

Secondary options

tramadol: 100 mg orally (immediate-release) initially, followed by 50-100 mg every 4-6 hours when required, maximum 400 mg/day; 50-100 mg intravenously every 4-6 hours when required

Tertiary options

morphine sulfate: 5-10 mg orally (immediate-release)/subcutaneously/intravenously/intramuscularly every 4 hours initially, adjust dose according to response

Plus – low-residue diet

2nd line – surgery

Plus – supportive therapy

Plus – intravenous antibiotic

Back

Plus –

intravenous antibiotic

Treatment recommended for ALL patients in selected patient group

Give intravenous antibiotics to patients admitted to secondary care with suspected complicated diverticulitis.[39]

Review intravenous antibiotics within 48 hours, or after the computed tomographic (CT) scan if sooner, and consider stepping down to oral antibiotics.[39]

Follow your local protocol or take advice from microbiology. However, in the UK, the National Institute for Health and Care Excellence recommends for suspected or confirmed complicated diverticulitis the following intravenous antibiotics:[39]

Amoxicillin/clavulanate
Cefuroxime plus metronidazole
Amoxicillin plus gentamicin and metronidazole
Ciprofloxacin (only in people with allergy to penicillins and cephalosporins; consider safety issues - see below) plus metronidazole.

Consult microbiology if alternative intravenous antibiotics are required.[39]

Prescribing restrictions apply to the use of fluoroquinolones, and these restrictions may vary between countries. In general, fluoroquinolones should be restricted for use in serious, life-threatening bacterial infections only. Some regulatory agencies may also recommend that they must only be used in situations where other antibiotics, that are commonly recommended for the infection, are inappropriate (e.g., resistance, contraindications, treatment failure, unavailability).
Consult your local guidelines and drug formulary for more information on suitability, contraindications, and precautions.

Consider any indications of sepsis in patients with complicated diverticulitis. See Sepsis in adults.

Practical tip

Sepsis

Think ‘Could this be sepsis?’ based on acute deterioration in a patient in whom there is clinical evidence or strong suspicion of infection.[45][46][47]

Use a systematic approach (e.g., National Early Warning Score 2 [NEWS2]), alongside your clinical judgement, to assess the risk of deterioration due to sepsis.[45][46][47][49][50] Consult local guidelines for the recommended approach at your institution. Arrange urgent review by a senior clinical decision-maker (e.g., ST3 level doctor in the UK) if you suspect sepsis:[45][51]

Within 30 minutes for a patient who is critically ill (e.g., NEWS2 score of 7 or more, evidence of septic shock, or other significant clinical concerns)
- A patient is also at high risk of severe illness or death from sepsis if they have a NEWS2 score below 7 and a single parameter contributes 3 points to their NEWS2 score and a medical review has confirmed that they are at high risk.
Within 1 hour for a patient who is severely ill (e.g., NEWS2 score of 5 or 6) or within 1 hour of any intervention for suspected sepsis (antibiotics/fluid resuscitation/oxygen) if there is no improvement in the patient’s condition.

In the community or custodial settings: refer for emergency medical care in hospital (usually by blue-light ambulance in the UK) any patient who is acutely ill with a suspected infection and is:[45]

Deemed to be at high risk of deterioration due to organ dysfunction (as measured by risk stratification)
At risk of neutropenic sepsis.

Treatment course: a 7- to 10-day course of antibiotics is often recommended on the premise that there is background acute inflammation/infection accounting for the bleeding.

Primary options

amoxicillin/clavulanate: 1.2 g intravenously every 8 hours

cefuroxime: 750 mg intravenously every 6-8 hours, may increase to 1500 mg every 6-8 hours in severe infections

and

metronidazole: 500 mg intravenously every 8 hours

amoxicillin: 500 mg intravenously every 8 hours, may increase to 1000 mg every 6 hours in severe infections

and

gentamicin: 5-7 mg/kg intravenously every 24 hours

and

metronidazole: 500 mg intravenously every 8 hours

Secondary options

ciprofloxacin: 400 mg intravenously every 8-12 hours

and

metronidazole: 500 mg intravenously every 8 hours

Plus – analgesia

Plus – low-residue diet

with abscess, perforation, fistulae, or obstruction

1st line – radiological drainage/surgery

Back

1st line –

radiological drainage/surgery

Surgical intervention may be considered for diverticular disease that fails to respond to medical management and for complications, including recurrent diverticulitis, abscess, perforation, fistulae, and obstruction.

Management of clinically stable, localised perforated diverticular disease has changed in recent years with a move towards fewer surgical interventions and non-operative management strategies in highly selected cohorts of patients.[93][94] This is not universally accepted, and not yet included in existing guidelines with strong evidence, so these approaches should only be carefully selected on a case-by-case basis with close clinical supervision.

Abscess

A localised abscess <3 cm in diameter does not warrant drainage and can be treated with antibiotics (see Intravenous antibiotic below).[6][54][82]

A localised abscess >3 cm in diameter may be drained under computed tomographic (CT) scan or ultrasound guidance; surgery is necessary if this cannot be accomplished.[6][39]

A CT scan of the abdomen with contrast is the imaging of choice for percutaneous drainage of abscess.

Send pus samples to microbiology in order to tailor antibiotic sensitivity.[39]

Consider further imaging if the patient does not improve or deteriorates.[39]

Bowel perforation

Consider diagnostic laparoscopy prior to exploratory laparotomy if the primary diagnosis is uncertain. Offer laparoscopic lavage or resectional surgery to patients with diverticular perforation with generalised peritonitis.[39] Discuss the risks and benefits of each procedure with the patient.[39]

Early laparoscopic washout is increasingly adopted as a surgical strategy for acute diverticulitis (Hinchey grades I, II, and III; see Aetiology for details of Hinchey classification) and when medical treatment and percutaneous drainage have failed to contain sepsis.[81][83][84][85][86][87][88] However, there is evidence that laparoscopic lavage for Hinchey III diverticulitis does not completely control the source of infection, and is associated with an increased rate of re-intervention.[89]
If faecal peritonitis is identified during laparoscopy, resectional surgery should be carried out.[39]

For patients with severe or diffuse peritonitis, emergency colectomy, a Hartmann's procedure (resection of the bowel with an end stoma), or colectomy with primary anastomosis (join in the bowel) may be necessary.[90] The National Institute for Health and Care Excellence in the UK recommends primary anastomosis with or without diverting stoma or Hartmann’s procedure based on patient characteristics, available expertise, and case-by-case basis.[39][92]

For select patients (Hinchey I, II, and III), and pending surgical expertise, a laparoscopic colectomy with primary anastomosis and/or a laparoscopic Hartmann's procedure is safe and may improve postoperative outcomes. [ ] [Evidence C]

Plus – intravenous antibiotic

Back

Plus –

intravenous antibiotic

Treatment recommended for ALL patients in selected patient group

Give intravenous antibiotics to patients admitted to secondary care with suspected complicated diverticulitis.[39]

Review intravenous antibiotics within 48 hours, or after the computed tomographic (CT) scan if sooner, and consider stepping down to oral antibiotics.[39]

Amoxicillin/clavulanate
Cefuroxime plus metronidazole
Amoxicillin plus gentamicin and metronidazole
Ciprofloxacin (only in people with allergy to penicillins and cephalosporins; consider safety issues - see below) plus metronidazole.

Consult microbiology if alternative intravenous antibiotics are required.[39]

Prescribing restrictions apply to the use of fluoroquinolones, and these restrictions may vary between countries. In general, fluoroquinolones should be restricted for use in serious, life-threatening bacterial infections only. Some regulatory agencies may also recommend that they must only be used in situations where other antibiotics, that are commonly recommended for the infection, are inappropriate (e.g., resistance, contraindications, treatment failure, unavailability).
Consult your local guidelines and drug formulary for more information on suitability, contraindications, and precautions.

Consider any indications of sepsis in patients with complicated diverticulitis. See Sepsis in adults.

Practical tip

Sepsis

Think ‘Could this be sepsis?’ based on acute deterioration in a patient in whom there is clinical evidence or strong suspicion of infection.[45][46][47]

Within 30 minutes for a patient who is critically ill (e.g., NEWS2 score of 7 or more, evidence of septic shock, or other significant clinical concerns)
- A patient is also at high risk of severe illness or death from sepsis if they have a NEWS2 score below 7 and a single parameter contributes 3 points to their NEWS2 score and a medical review has confirmed that they are at high risk.
Within 1 hour for a patient who is severely ill (e.g., NEWS2 score of 5 or 6) or within 1 hour of any intervention for suspected sepsis (antibiotics/fluid resuscitation/oxygen) if there is no improvement in the patient’s condition.

In the community and custodial settings: refer for emergency medical care in hospital (usually by blue-light ambulance in the UK) any patient who is acutely ill with a suspected infection and is:[45]

Deemed to be at high risk of deterioration due to organ dysfunction (as measured by risk stratification)
At risk of neutropenic sepsis.

Treatment course: patients should continue on intravenous antibiotics, completing a course of up to 14 days in people with CT-confirmed diverticular abscess. It may be possible to switch to oral antibiotics for patients with abscesses <3 cm.

Primary options

amoxicillin/clavulanate: 1.2 g intravenously every 8 hours

cefuroxime: 750 mg intravenously every 6-8 hours, may increase to 1500 mg every 6-8 hours in severe infections

and

metronidazole: 500 mg intravenously every 8 hours

amoxicillin: 500 mg intravenously every 8 hours, may increase to 1000 mg every 6 hours in severe infections

and

gentamicin: 5-7 mg/kg intravenously every 24 hours

and

metronidazole: 500 mg intravenously every 8 hours

Secondary options

ciprofloxacin: 400 mg intravenously every 8-12 hours

and

metronidazole: 500 mg intravenously every 8 hours

Plus – analgesia

Plus – low-residue diet

ONGOING

recurrent diverticulitis

1st line – elective surgery

Back

1st line –

elective surgery

Consider elective open or laparoscopic resection for patients who have recovered from complicated acute diverticulitis but have continuing symptoms (such as stricture or fistula).[39]

Criteria for recommending elective colectomy for recurrent disease are not clear cut and should not be based on the number of previous attacks alone. Make judgements on an individual basis depending on age, frequency, and severity of recurrent symptoms; previous complications; presence of comorbidities; and patient preferences and values.[12][35][95][96] In elective settings, laparoscopic colonic resection is feasible and safe, may hasten postoperative recovery, and has fewer postoperative complications than conventional surgery, including surgical site infections.[97][98][99]

Prophylactic oral antibiotic administration one day before surgery reduces the incidence of surgical-site infection, without mechanical bowel preparation, in such patients.[100]

Mesalazine, probiotics, or rifaximin are not recommended for the prevention of recurrent diverticulitis.[12][101] Evidence shows that mesalazine does not reduce the risk of recurrence.[102] [ ] There is insufficient evidence for the use of rifaximin, mesalazine and rifaximin in combination, balsalazide (a 5-aminosalicylic acid prodrug) and probiotics in combination, or burdock tea.[101][102]

Do not offer an aminosalicylate or antibiotics to prevent recurrent acute diverticulitis.[39]

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Diverticular disease

Treatment algorithm

asymptomatic diverticulosis

dietary and lifestyle modifications

Practical tip

symptomatic diverticular disease

dietary and lifestyle modifications

analgesia

Primary options

These drug options and doses relate to a patient with no comorbidities.

Primary options

Drug choice, dose and interactions may be affected by the patient's comorbidities. Check your local drug formulary.

Primary options

antispasmodic

Primary options

These drug options and doses relate to a patient with no comorbidities.

Primary options

Drug choice, dose and interactions may be affected by the patient's comorbidities. Check your local drug formulary.

Primary options

acute diverticulitis (uncomplicated)

analgesia

Primary options

These drug options and doses relate to a patient with no comorbidities.

Primary options

Drug choice, dose and interactions may be affected by the patient's comorbidities. Check your local drug formulary.

Primary options

antispasmodic

Primary options

These drug options and doses relate to a patient with no comorbidities.

Primary options

Drug choice, dose and interactions may be affected by the patient's comorbidities. Check your local drug formulary.

Primary options

oral antibiotic

More info: Antibiotics in uncomplicated diverticulitis

Primary options

Secondary options

Tertiary options

These drug options and doses relate to a patient with no comorbidities.

Primary options

Secondary options

Tertiary options

Drug choice, dose and interactions may be affected by the patient's comorbidities. Check your local drug formulary.

Primary options

Secondary options

Tertiary options

low-residue diet

acute diverticulitis (complicated)

with acute rectal bleeding

stratify as stable or unstable and manage bleeding

supportive therapy

intravenous antibiotic

Practical tip

Primary options

Secondary options

These drug options and doses relate to a patient with no comorbidities.

Primary options

Secondary options

Drug choice, dose and interactions may be affected by the patient's comorbidities. Check your local drug formulary.

Primary options

Secondary options

analgesia

Primary options

Secondary options

Tertiary options

These drug options and doses relate to a patient with no comorbidities.

Primary options

Secondary options

Tertiary options

Drug choice, dose and interactions may be affected by the patient's comorbidities. Check your local drug formulary.

Primary options

Secondary options

Tertiary options

low-residue diet

surgery

supportive therapy

intravenous antibiotic

Practical tip

Primary options

Secondary options

These drug options and doses relate to a patient with no comorbidities.