Diverticulitis is rarely seen in the pediatric age group. Over the course of nearly 30 years, I have encountered two cases; though, many of my partners with longer clinical experience have seen none.
If/when you seen diverticulitis, here’s a link to AGA Clinical Practice Update (AF Peery et al. Gastroenterol 2021;160: 906-911): AGA Clinical Practice Update on Medical Management of Colonic Diverticulitis: Expert Review
Recommendations include the following:
- Best Practice Advice 1: Computed tomography should be considered to confirm the diagnosis of diverticulitis in patients without a prior imaging-confirmed diagnosis and to evaluate for potential complications in patients with severe presentations. Imaging should also be considered in those who fail to improve with therapy, are immunocompromised, or who have multiple recurrences and are contemplating prophylactic surgery in order to confirm the diagnosis and location(s) of disease.
- Best Practice Advice 3: After an acute episode of diverticulitis, colonoscopy should be delayed by 6–8 weeks or until complete resolution of the acute symptoms, whichever is longer. Colonoscopy should be considered sooner if alarm symptoms are present.
- Best Practice Advice 5: A clear liquid diet is advised during the acute phase of uncomplicated diverticulitis. Diet should advance as symptoms improve.
- Best Practice Advice 7: Antibiotic treatment is advised in patients with uncomplicated diverticulitis who have comorbidities or are frail, who present with refractory symptoms or vomiting, or who have a C-reactive protein >140 mg/L or baseline white blood cell count > 15 × 109 cells/L. Antibiotic treatment is advised in patients with complicated diverticulitis or uncomplicated diverticulitis with a fluid collection or longer segment of inflammation on CT scan.
- Best Practice Advice 9: To reduce the risk of recurrence, patients with a history of diverticulitis should consume a high-quality diet, achieve or maintain a normal body mass index, be routinely physically active, and not smoke. Additionally, patients with a history of diverticulitis should avoid regular use (2 or more times per week) of nonsteroidal anti-inflammatory drugs except aspirin prescribed for secondary prevention of cardiovascular disease.
Dear Jay, as always, thank you for the gift of knowledge you bring to our pediatric gastroenterology community. Guts and Growth is a fabulous resource for the field and we are privileged to have you doing this so passionately and consistently over the years. Regarding diverticulitis in children, I learned only last week in a Grand Rounds on Williams syndrome that this chromosomal disorder seems to have an increased occurrence of colonic diverticular disease in adolescents. There are a small handful of references — Diverticulitis in a child with Williams syndrome: a case report and review of the literature. j.jpedsurg.2012.05.036 [doi]. Just and interesting FYI. Hope you are doing well. — John