Who Can Safely Be Discharged Home with Diverticulitis? What Discharge Instructions Do I Give Patients with Diverticulitis?

  • Elaine Bromberek
  • Autumn Graham


Diverticulitis is a disease affecting over 70% of Americans over the age of 80. It is defined as an inflammation of an outpouching of the colon, and episodes range in severity from mild pain and leukocytosis to peritonitis and septic shock requiring immediate surgical intervention. Current recommendations are for evaluation of the patient with signs and symptoms of diverticulitis with laboratory studies and CT for risk stratification. Patients that are low risk may qualify for outpatient treatment. Despite recommendations for many years, neither fiber nor probiotics have been shown to have a significant effect on the course of disease, and neither is currently recommended by the AGA.


Diverticulitis Discharge Disposition Probiotics Colonoscopy 


  1. 1.
    Paolillo C, Spallino I. Is it safe to send home an uncomplicated diverticulitis? DIVER Trial Intern Emerg Med. 2015;10:193–4. Scholar
  2. 2.
    Sirany AM, Gaertner W, Madoff R, KWaan M. Diverticulitis diagnosed in the emergency room: is it safe to discharge home? J Am Coll Surg. 2017;225(1):21–5. Scholar
  3. 3.
    Etzioni D, Chiu Y, Cannom R, Burchette RJ, Haigh PI, Abbas MA. Outpatient treatment of acute diverticulitis: rates and predictors of failure. Dis Colon Rectum. 2010;53:861–5.CrossRefGoogle Scholar
  4. 4.
    Joliat GR, Emery J, Demartines N, Hubner M, Yersin B, Hahnloser D. Antibiotic treatment for uncomplicated and mild complicated diverticulitis: outpatient treatment for everyone. Int J Color Dis. 2017;32:1313–9.CrossRefGoogle Scholar
  5. 5.
    Morris A, Regenbogen S, Hardiman K, Hendren S. Sigmoid diverticulitis: a systematic review. JAMA. 2014;311(3):287–97. Scholar
  6. 6.
    Deery SA, Hodin RA. Management of diverticulitis in 2017. J Gastroinest Surg. 2017;21(10):1732–41. Scholar
  7. 7.
    Lue A, Laredo V, Lanas A. Medical treatment of diverticular disease: antibiotics. J Clin Gastroenterol. 2016;50:S57–9.CrossRefGoogle Scholar
  8. 8.
    Chabok A, Pahlman A, Hjern R, Haapaniemi S, Smedh K, AVOD Study Group. Randomized clinical trial of antibiotics in acute uncomplicated diverticulitis. Br J Surg. 2012;99(4):532–9.CrossRefGoogle Scholar
  9. 9.
    Daniels L, Unlu C, de Korte N, et al. Dutch diverticular disease (3D) collaborative study group. Randomized clinical trial of observational versus antibiotic treatment for a first episode of CT-proven uncomplicated acute diverticulitis. Br J Surg. 2017;104:52–61.CrossRefGoogle Scholar
  10. 10.
    Stollman N, Smalley W, Hirano I, AGA Institute Clinical Guidelines Committee. American Gastroenterological Association Institute guideline on the management of acute diverticulitis. Gastroenterology. 2015;149:1944–9.CrossRefGoogle Scholar
  11. 11.
    Feurstein J, Falchuk K. Diverticulosis and diverticulitis. Mayo Clin Proc. 2016;1(8):1094–104.CrossRefGoogle Scholar
  12. 12.
    Carabotti M, Annibale B, Severi C, Lahner E. Role of fiber in symptomatic uncomplicated diverticular disease: a systematic review. Nutrients. 2017;9:161. Scholar
  13. 13.
    Tursi A. Dietary pattern and colonic diverticulosis. Curr Opin Clin Nutr Metab Care. 2017;20:409–13. Scholar
  14. 14.
    Strate L, Liu Y, Syngal S, Aldoori WH, Giovannucci EL. Nut, corn, and popcorn consumption and the incidence of diverticular disease. JAMA. 2008;300(8):907–14. Scholar
  15. 15.
    Strate L, Keeley B, Cao Y, Wu K, Giovannucci EL, Chan AT. Western dietary pattern increases, and prudent dietary pattern decreases, risk of incident diverticulitis in a prospective cohort study. Gastroenterology. 2017;152:1023–30.CrossRefGoogle Scholar
  16. 16.
    Dughera L, Serra AM, Battaglia E, Tibaudi D, Navino M, Emanuelli G. Acute recurrent diverticulitis is prevented by oral administration of a polybacterial lysate suspension. Minerva Gastroenterol Dietol. 2004;50:149–53.PubMedGoogle Scholar
  17. 17.
    Tursi A, Brandimarte G, Daffina R. Long-term treatment with mesalazine and rifaximin versus rifaximin alone for patients with recurrent attacks of acute diverticulitis of colon. Dig Liver Dis. 2002;34:510–5.CrossRefGoogle Scholar
  18. 18.
    Strate LL, Peery AF, Neumann I. American Gastroenterological Association Institute technical review on the management of acute diverticulitis. Gastroenterology. 2015;149(7):1950–76.CrossRefGoogle Scholar
  19. 19.
    Andeweg CS, Mulder IM, Felt-Bersma RJF, Verbon A, van der Wilt GJ, van Goor H, et al. Guidelines of diagnostics and treatment of acute left-sided colonic diverticulitis. Dig Surg. 2013;30:278–92.CrossRefGoogle Scholar
  20. 20.
    Daniels L, Unlu C, de Wijkerslooth TR, Dekker E, Boermeester MA. Routine colonoscopy after left-sided acute uncomplicated diverticulitis: a systematic review. Gastrointest Endosc. 2014;79:378–98.CrossRefGoogle Scholar
  21. 21.
    Krones CJ, Klinge U, Butz N, Junge K, Stumpf M, Rosch R, et al. The rare epidemiologic coincidence of diverticular disease and advanced colonic neoplasia. Int J Color Dis. 2006;21:18–24.CrossRefGoogle Scholar
  22. 22.
    Stefánsson T, Ekbom A, Sparèn P, Påhlman L. Association between sigmoid diverticulitis and left-sided colon cancer: a nested, population-based, case control study. Scand J Gastroenterol. 2004;39:743–7.CrossRefGoogle Scholar
  23. 23.
    Meurs-Szojda MM, Terhaar sive Droste JS, Kuik DJ, Mulder CJ, Felt-Bersma RJ. Diverticulosis and diverticulitis form no risk for polyps and colorectal neoplasia in 4,241 colonoscopies. Int J Color Dis. 2008;23:979–84.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Elaine Bromberek
    • 1
  • Autumn Graham
    • 2
  1. 1.MedStar Washington Hospital Center, MedStar Georgetown University HospitalWashington, DCUSA
  2. 2.Department of Emergency MedicineMedStar Washington Hospital Center, MedStar Georgetown University HospitalWashington, DCUSA

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