Overview
Diverticulitis of the sigmoid colon involves inflammation of diverticula in the sigmoid segment of the colon, often presenting with abdominal pain, fever, and leukocytosis. Complications can include abscess formation and vascular involvement such as thrombophlebitis 1.Diagnosis
Clinical Presentation: Fever, abdominal pain, vomiting, leukocytosis 1
Imaging: Abdominal CT scan essential for diagnosis, revealing diverticula, abscesses, and vascular complications like thrombophlebitis 1
Laboratory Tests: Elevated CRP, anemia, positive blood cultures (if sepsis is present) 1Management
First-Line Treatment:
- Antibiotics: Broad-spectrum coverage based on culture results (e.g., Gram-negative and Streptococcus viridans coverage) 1
- Anticoagulation: For patients with documented vascular thrombosis 1
Adjunctive Treatments:
- Surgical Intervention: Delayed surgery (e.g., left hemicolectomy) after resolution of acute symptoms and septic status 1Special Populations
Comorbidities: Management may need adjustment in patients with rheumatoid arthritis, considering potential interactions and complications 1Key Recommendations
Initiate broad-spectrum antibiotics targeting identified pathogens and anticoagulate for vascular thrombosis in cases of sigmoid diverticulitis with thrombophlebitis (Evidence: Moderate) 1
Employ a medical approach initially, reserving delayed surgical intervention (e.g., hemicolectomy) for resolution of acute symptoms and septic status (Evidence: Weak) 1
Monitor closely for signs of systemic infection and vascular complications, utilizing CT imaging to guide management decisions (Evidence: Expert opinion) 1References
1 Nobili C, Uggeri F, Romano F, Degrate L, Caprotti R, Perego P et al.. Pylephlebitis and mesenteric thrombophlebitis in sigmoid diverticulitis: medical approach, delayed surgery. Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver 2007. link