Patient handout

Acute Colonic Diverticulitis (uncomplicated vs complicated — modified Hinchey) + post-recovery management

PRODUCTION

1. Your condition

This handout is for acute colonic diverticulitis (uncomplicated vs complicated — modified hinchey) + post-recovery management. Your care team identified this based on: left lower quadrant abdominal pain (classic left-sided diverticulitis) (ascrs 2020).

Other reasons your team may use this plan: right lower quadrant pain — right-sided / caecal diverticulitis (asian, younger; appendicitis mimic) (wses 2020); change in bowel habit + low-grade fever ± nausea (aga cpu 2021); leukocytosis ± crp elevation with abdominal pain (mäkelä 2015 pmid 25665622).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
observation_clear_liquid_diet	Clear liquids → advance as tolerated	PO	continuous	AVOD (Chabok Br J Surg 2012 PMID 22290281; long-term PMID 31386199) + DIABOLO (Daniels Br J Surg 2017 PMID 29700480): antibiotics did NOT shorten recovery, prevent complications, or reduce recurrence — observation is equivalent
acetaminophen	500–1000 mg PO q6h (max 3 g/day)	PO	q6h	Preferred analgesic; AVOID NSAIDs/opioids — associated with perforation risk and constipation (AGA CPU 2021)

Plan: Diverticulitis antibiotic strategy — selective (uncomplicated) vs IV (complicated) (ASCRS 2020 + AGA CPU 2021 + WSES 2020 + AVOD/DIABOLO)

3. When to call your provider

Contact your care team if any of the following happen:

No improvement / worsening at 48–72 h → ED + CT + IV antibiotics (ASCRS 2020)
Fever, peritoneal signs, sepsis features → ED (WSES 2020)
Inability to tolerate PO → ED for IV therapy (AGA CPU 2021)

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

Generalised peritoneal signs + free intraperitoneal air on CT (Hinchey III/IV) (WSES 2020)(life-threatening)
Hypotension despite adequate fluids + lactate >2 + suspected faeculent peritonitis (WSES 2020; SSC 2026)(life-threatening)
CT shows diverticular abscess ≥4 cm (Hinchey Ib/II) (ASCRS 2020)
Diverticulitis in transplant / chronic steroid / biologic / cytotoxic-immunosuppressed host (AGA CPU 2021; ASCRS 2020)
Obstipation + bowel dilatation/transition point on CT from diverticular stricture (WSES 2020)
Painless hematochezia (diverticular bleeding) — DISTINCT from diverticulitis (ACG 2023)

5. Follow-up

Subacute recovery: interval colonoscopy 6–8 wk after resolution if no quality colonoscopy within ~1 yr (CRC yield ~1.9%, higher in complicated) — exclude malignancy/IBD; lifestyle (high-fibre diet, physical activity, weight, smoking cessation; nuts/seeds NOT restricted — debunked myth, counsel patient); individualised elective-surgery shared decision (NOT episode count) for smouldering/chronic, fistula, stricture, immunosuppressed, or inability to exclude cancer; chemoprophylaxis anti-pattern (no mesalamine/rifaximin/probiotics) (AGA CPU 2021; ASCRS 2020)

6. Sources

Guideline: ASCRS 2020 Treatment of Left-Sided Colonic Diverticulitis (Hall, Dis Colon Rectum) + AGA Clinical Practice Update on Medical Management of Colonic Diverticulitis 2021 (Peery/Shaukat/Strate) + WSES 2020 acute colonic diverticulitis (Sartelli)