Diverticulitis natural history, complications and prognosis
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2] James Nasr[3]
Overview
Diverticulitis natural history is still being clarified. Diverticulitis can cause many complications that can be fatal in some cases. These complications include abscess, perforation, peritonitis, and fistula formation. Prognosis of diverticulitis is excellent; more than 90% of patients with uncomplicated diverticulitis improve with conservative management, and recurrence risk is lower than previously believed.[1]
Natural History
The natural history of diverticulitis is still not well understood. However, some studies have shown the disease to take a benign course with a low incidence of complications if left untreated.[2][3]
Complications
In complicated diverticulitis, bacteria may subsequently infect the outside of the colon if an inflamed diverticulum bursts open. If the infection spreads to the lining of the abdominal cavity (peritoneum), this can cause potentially fatal peritonitis. Sometimes, inflamed diverticula can cause narrowing of the bowel, causing an obstruction. Also, the affected part of the colon could adhere to the bladder or other adjacent organs, causing a fistula. These complications always require treatment to prevent them from progressing and causing serious illness.[4]
Abscess
- Abscess formation may take place in cases of diverticulitis.[5]
- The abscess can be detected by CT scan and can be resolved with antibiotics. If the abscess persists, cutaneous drainage is recommended.
Perforation and peritonitis
- Perforation can lead to secondary peritonitis due to chemical irrigation by feces.[6]
- This is rare but may be fatal.
Fistula
- Fistula formation is another complication of acute diverticulitis. It occurs between the colon and its adjacent structures, especially the bladder forming the colovesical fistula.
- Genitourinary manifestations may present as dysuria.[7]
Prognosis
In patients with acute uncomplicated diverticulitis, conservative treatment is successful in 70 to 100 percent of patients and mortality is negligible.[8]
References
- ↑ Brown RF, Lopez K, Smith CB, Charles A. Diverticulitis: A Review. JAMA. Published online July 24, 2025. doi:10.1001/jama.2025.10234
- ↑ Salem TA, Molloy RG, O’Dwyer PJ (2007). “Prospective, five-year follow-up study of patients with symptomatic uncomplicated diverticular disease”. Dis Colon Rectum. 50 (9): 1460–4. doi:10.1007/s10350-007-0226-5. PMID 17431721. Review in: J Fam Pract. 2007 Dec;56(12):992
- ↑ Floch MH, Bina I (2004). “The natural history of diverticulitis: fact and theory”. J Clin Gastroenterol. 38 (5 Suppl 1): S2–7. PMID 15115921.
- ↑ Morris AM, Regenbogen SE, Hardiman KM, Hendren S (2014). “Sigmoid diverticulitis: a systematic review”. JAMA. 311 (3): 287–97. doi:10.1001/jama.2013.282025. PMID 24430321.
- ↑ Bahadursingh AM, Virgo KS, Kaminski DL, Longo WE (2003). “Spectrum of disease and outcome of complicated diverticular disease”. Am J Surg. 186 (6): 696–701. PMID 14672782.
- ↑ Nagorney DM, Adson MA, Pemberton JH (1985). “Sigmoid diverticulitis with perforation and generalized peritonitis”. Dis Colon Rectum. 28 (2): 71–5. PMID 3971809.
- ↑ Woods RJ, Lavery IC, Fazio VW, Jagelman DG, Weakley FL (1988). “Internal fistulas in diverticular disease”. Dis Colon Rectum. 31 (8): 591–6. PMID 3402284.
- ↑ Rafferty J, Shellito P, Hyman NH, Buie WD (2006). “Practice parameters for sigmoid diverticulitis”. Dis. Colon Rectum. 49 (7): 939–44. doi:10.1007/s10350-006-0578-2. PMID 16741596.
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