Journal of Gastrointestinal Surgery

, Volume 14, Issue 2, pp 303–308 | Cite as

The Diagnosis of Diverticulitis in Outpatients: On What Evidence?

  • Erin S. O’Connor
  • Glen Leverson
  • Gregory Kennedy
  • Charles P. Heise
Original Article



Diverticular disease is common in the outpatient setting; yet, rigorous study of diagnosis and management strategies is currently limited to hospitalized patients. Here, we characterize the clinical assessment generating the diagnostic label of diverticulitis in outpatients.


Encounters for diverticulitis were identified using ICD-9 diagnosis codes (562.11/562.13) from the electronic medical record system of a tertiary referral hospital and its regional clinics. The frequencies of various demographic and clinical variables were compared between patients presenting in the emergency room (ER) or outpatient Clinic.


Between 2003 and 2008, 820 inpatients and 2,576 outpatients met inclusion criteria (328 [13%] ER, 2,248 [87%] Clinic). Compared to ER patients, Clinic patients were less likely to undergo urgent abdominal/pelvic computed tomography (CT) scan (14% vs. 85%, p < .0001) or have an abnormal WBC count (35% vs. 69%, p < .0001). Twenty-four-hour events, including inpatient admission (30% ER vs. 3.5% Clinic, p < .0001) and colectomy (1.2% ER vs. 0.4% Clinic, p = 0.08) were rare in both groups.


Diverticulitis in the outpatient setting is often characterized by infrequent use of CT scans, lack of leukocytosis, and rare need for urgent surgery or early admission. As this diagnostic label appears to be commonly applied without objective evidence, further study is needed to evaluate its validity.


Diverticulitis Outpatient Diagnostic strategy Diverticulosis 


  1. 1.
    Hughes LE. Postmortem survey of diverticular disease of the colon. I. Diverticulosis and diverticulitis. Gut 1969;10(5):336–344.CrossRefPubMedGoogle Scholar
  2. 2.
    Parks TG. Natural history of diverticular disease of the colon. Clin Gastroenterol 1975;4(1):53–69.PubMedGoogle Scholar
  3. 3.
    Welch CE, Allen AW, Donaldson GA. An appraisal of resection of the colon for diverticulitis of the sigmoid. Ann Surg 1953;138(3):332–343.PubMedGoogle Scholar
  4. 4.
    Parks TG. Natural history of diverticular disease of the colon. A review of 521 cases. Br Med J 1969;4(5684):639–642.CrossRefPubMedGoogle Scholar
  5. 5.
    Heise CP. Epidemiology and pathogenesis of diverticular disease. J Gastrointest Surg 2008;12(8):1309–1311.CrossRefPubMedGoogle Scholar
  6. 6.
    Stollman N, Raskin JB. Diverticular disease of the colon. Lancet 2004;363(9409):631–639.CrossRefPubMedGoogle Scholar
  7. 7.
    Horner J. A study of diverticulitis of the colon in office practice. Gastroenterology 1952;21(2):223–229.PubMedGoogle Scholar
  8. 8.
    Wong WD, Wexner SD, Lowry A et al. Practice parameters for the treatment of sigmoid diverticulitis–supporting documentation. The Standards Task Force. The American Society of Colon and Rectal Surgeons. Dis Colon Rectum 2000;43(3):290–297.CrossRefPubMedGoogle Scholar
  9. 9.
    Rafferty J, Shellito P, Hyman NH, Buie WD. Practice parameters for sigmoid diverticulitis. Dis Colon Rectum 2006;49(7):939–944.CrossRefPubMedGoogle Scholar
  10. 10.
    Stollman NH, Raskin JB. Diagnosis and management of diverticular disease of the colon in adults. Ad Hoc Practice Parameters Committee of the American College of Gastroenterology. Am J Gastroenterol 1999;94(11):3110–3121.CrossRefPubMedGoogle Scholar
  11. 11.
    Salzman H, Lillie D. Diverticular disease: diagnosis and treatment. Am Fam Physician 2005;72(7):1229–1234.PubMedGoogle Scholar
  12. 12.
    Etzioni DA, Mack TM, Beart RW Jr, Kaiser AM. Diverticulitis in the United States: 1998–2005: changing patterns of disease and treatment. Ann Surg 2009;249(2):210–217.CrossRefPubMedGoogle Scholar
  13. 13.
    Chautems RC, Ambrosetti P, Ludwig A, Mermillod B, Morel P, Soravia C. Long-term follow-up after first acute episode of sigmoid diverticulitis: is surgery mandatory?: a prospective study of 118 patients. Dis Colon Rectum 2002;45(7):962–966.CrossRefPubMedGoogle Scholar
  14. 14.
    Salem L, Anaya DA, Flum DR. Temporal changes in the management of diverticulitis. J Surg Res 2005;124(2):318–323.CrossRefPubMedGoogle Scholar
  15. 15.
    Salem TA, Molloy RG, O’Dwyer PJ. Prospective, five-year follow-up study of patients with symptomatic uncomplicated diverticular disease. Dis Colon Rectum 2007;50(9):1460–1464.CrossRefPubMedGoogle Scholar
  16. 16.
    Delvaux M. Diverticular disease of the colon in Europe: epidemiology, impact on citizen health and prevention. Aliment Pharmacol Ther 2003;18(Suppl 3):71–74.CrossRefPubMedGoogle Scholar
  17. 17.
    United States Department of Health Education and Welfare. Report to the Congress of the United States of the National Commission on Digestive Diseases. In: United States Department of Health Education and Welfare (ed). Volume 4, DHEW publication no. NIH-79. Washington DC: Government Printing Office, 1887.Google Scholar
  18. 18.
    Broderick-Villa G, Burchette RJ, Collins JC, Abbas MA, Haigh PI. Hospitalization for acute diverticulitis does not mandate routine elective colectomy. Arch Surg 2005;140(6):576–581. discussion 81–3.CrossRefPubMedGoogle Scholar
  19. 19.
    Anaya DA, Flum DR. Risk of emergency colectomy and colostomy in patients with diverticular disease. Arch Surg 2005;140(7):681–685.CrossRefPubMedGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2009

Authors and Affiliations

  • Erin S. O’Connor
    • 1
  • Glen Leverson
    • 1
  • Gregory Kennedy
    • 1
  • Charles P. Heise
    • 1
    • 2
  1. 1.Department of SurgeryUniversity of Wisconsin School of Medicine and Public HealthMadisonUSA
  2. 2.H4/746 Clinical Science CenterMadisonUSA

Personalised recommendations