Lower Gastrointestinal Conditions: Diverticular Disease.

Diverticular disease is a spectrum of conditions related to diverticulosis and includes symptomatic uncomplicated diverticular disease, segmental colitis associated with diverticulosis, diverticular bleeding, and diverticulitis. The spectrum of pathology contributes significantly to gastrointestinal comorbidities and increases in prevalence with age. Diverticulosis is associated with low dietary fiber intake, obesity, an inactive lifestyle, and family history. Patients with diverticulitis typically present with left lower quadrant pain and an elevated white blood cell count or C-reactive protein level. The diagnosis is made by clinical examination with or without imaging. Management of diverticulitis includes intravenous fluids and antibiotics, although recent studies have shown that the latter may be avoided in select patients with uncomplicated diverticulitis. The need for hospitalization is determined by patient presentation and complications identified on imaging. Surgery is indicated in patients with frank perforation, unsuccessful conservative management of an abscess, or lack of improvement with conservative therapy. Elective interval colectomy should be considered on an individual basis. Colonoscopy should be performed 4 to 8 weeks after resolution of diverticulitis to exclude colorectal cancer. For secondary prevention, a high-fiber diet and vigorous physical activity are recommended.