Diverticulitis

Diverticula are small outpouchings that form where the colon wall is weakest, most often in the sigmoid colon on the left side. Having them (diverticulosis) is extremely common with age and usually silent. Diverticulitis is what happens when one becomes inflamed or micro-perforates, producing persistent left lower abdominal pain, fever, and often a change in bowel habit. The management picture has shifted substantially in the last decade. Uncomplicated diverticulitis — inflammation without abscess, perforation, obstruction, or fistula — often does not require antibiotics at all in immunocompetent patients, with randomized trials showing observation performs comparably. Complicated disease still requires antibiotics, drainage, or surgery. The prevention story has also been rewritten: the long-standing advice to avoid nuts, seeds, popcorn, and corn was based on nothing, and a large prospective cohort found those foods were associated with lower, not higher, risk. What genuinely reduces recurrence is a high-fiber diet, physical activity, weight management, not smoking, and limiting red meat and NSAIDs.

• •Persistent pain in the lower left abdomen, often constant rather than colicky
• •Fever and chills during an acute attack
• •Change in bowel habit — constipation more often than diarrhea
• •Nausea, vomiting, and abdominal tenderness
• •Bloating and localized guarding on examination
• •Complicated disease: severe pain, high fever, inability to pass gas or stool, or urine containing gas or stool (fistula)

• •Age-related weakening of the colon wall — diverticula are present in most people over 60
• •Low dietary fiber, associated with higher risk in prospective cohorts
• •Obesity and physical inactivity
• •Smoking, which increases risk of complicated disease
• •Regular NSAID and opioid use
• •Genetic predisposition — heritability is substantial
• •Altered gut microbiome and chronic low-grade inflammation

The acute attack and the long-term risk need different approaches. Acutely, uncomplicated diverticulitis in an otherwise healthy person is increasingly managed with observation, clear fluids or a low-residue diet, and analgesia, with antibiotics reserved for those who are immunocompromised, systemically unwell, or have complicated disease on imaging. Long-term prevention runs on fiber: a high-fiber diet is associated with meaningfully lower recurrence, alongside regular exercise, maintaining a healthy weight, stopping smoking, minimizing NSAIDs, and moderating red meat intake. Elective surgery is reserved for recurrent complicated disease or persistent complications, not simply for a count of past episodes.