Diverticular disease as its own entity, following a management algorithm that shifted meaningfully in the last decade while the boards catch up. Uncomplicated diverticulitis is now an inflammatory process treated with selective rather than reflex antibiotics, and prophylactic resection by episode count is dead. Complicated disease grades on Hinchey and splits at the four-centimeter abscess threshold. Topics covered Diverticulosis anatomy and false diverticula Acute diverticulitis and CT grading Hinchey classification of complicated disease Selective antibiotics in uncomplicated disease Complicated disease and abscess thresholds Recurrence and elective surgery indications Segmental colitis (SCAD) as IBD mimic Modifiable risk factors and post-episode workup Key decisions Well-appearing immunocompetent outpatient with uncomplicated left-sided diverticulitis gets supportive care with selective, not reflex, antibiotics; ciprofloxacin plus metronidazole is the wrong move. Antibiotics remain standard for the immunocompromised, frail, septic, admitted, or any complicated CT feature, because these hosts cannot mount the response that drives spontaneous resolution. Pericolic abscess under four centimeters resolves with antibiotics alone; four centimeters or larger gets percutaneous drainage plus IV antibiotics, not urgent sigmoidectomy. Elective resection is reserved for debilitating recurrences, prior complicated attacks, or immunocompromise, never a fixed episode count in immunocompetent patients. Colonoscopy six to eight weeks after a first episode is mandatory to exclude a perforating sigmoid cancer masquerading on CT. Segmental colitis spares the rectum and proximal colon, rests on segmental distribution not histology, and responds to mesalamine, not an IBD diagnosis. For the full chapter with MCQs, tables, and primary-guideline references, visit www.boardpearls.com. Questions or feedback: [email protected]. (00:00) - Why the algorithm shifted (00:54) - Anatomy of diverticulosis (02:00) - Acute diverticulitis and CT grading (03:05) - Selective antibiotics in uncomplicated disease (05:06) - Complicated disease and abscess thresholds (06:48) - Recurrence and elective surgery (09:13) - Segmental colitis, the IBD mimic

Ask this episode

“What did the council decide on item 42?” — answered with the speaker and the moment.

Transcript

Related