GASTROENTEROLOGY ARTICLE OF THE WEEK
January 3, 2008
Jacobs DO. Diverticulitis. N Engl J Med 2007;357:2057-66
1. Patients who are immunocompromised or taking chronic steroids
a. are less likely to develop diverticulitis
b. are less likely to respond to conservative measures
c. do better with surgery, and have a low postoperative risk of complications
d. may present with mild symptoms despite complicated diverticulitis
2. Antibiotic regimens that are effective to treat diverticulitis include
a. metronidazole and first generation cephalosporin
b. metronidazole and a quinolone
c. amoxicillin-clavulanate and a quinolone
d. amoxicillin-clavulanate monotherapy
e. metronidazole and trimethoprim-sulfamethoxazole
f. metronidazole and 3rd generation cephalosporin
True or False
3. In questionable cases, the use of a limited barium enema can help clarify the clinical picture
4. Repeated episodes of uncomplicated diverticulitis is not a clear indication for surgery
5. Perforation, usually microscopic, is often present when diverticulitis develops
6. Diverticulosis is more common in men
7. Most patients who have diverticulitis will have recurrent episodes
8. Feculent material aspirated from a peri-diverticular abscess is a strong indication for surgical intervention.
9. Streptococcal bacteremia would be highly unusual from diverticulitis
10. CT guided drainage of a peridiverticular abscess should be strongly considered when the abscess is > 4cm,
11. Obese patients, and those under age 50 who present with diverticulitis are more likely to require surgical intervention
12. High fiber diet clearly reduces the risk of recurrence of acute diverticulitis