#510 Diverticulitis for the Hospitalist

Diverticulitis involves inflammation of pre-existing colonic outpouchings, requiring careful distinction between uncomplicated and complicated disease. Uncomplicated cases often respond to supportive care, with selective antibiotic use—typically amoxicillin-clavulanate or fluoroquinolones plus metronidazole—reserved for patients with systemic signs of inflammation. Complicated disease, characterized by abscesses, perforations, or fistulas, necessitates hospital admission and intravenous antibiotics. While CT imaging serves as the gold standard for diagnosis and assessing complications, surgical intervention or interventional radiology drainage becomes necessary when abscesses exceed three centimeters or patients fail to improve. Contrary to common myths, dietary restrictions regarding seeds and nuts lack clinical evidence, and elective surgery remains a shared decision-making process based on patient quality of life rather than the mere frequency of previous episodes.