Diverticulitis is a condition involving the inflammation or infection of small, bulging pouches, known as diverticula, that form in the lining of the large intestine or colon. This common gastrointestinal problem can range from a mild flare-up to a severe medical emergency requiring hospitalization. The proper care for diverticulitis relies on a coordinated team of specialists to manage the acute infection, prevent complications, and guide long-term health. The specific type of doctor needed depends entirely on the severity of the condition and the stage of treatment.
Primary Care and Initial Assessment
The first point of medical contact for a patient experiencing symptoms of diverticulitis is typically a Primary Care Physician (PCP) or Family Doctor. The PCP performs the initial evaluation, which includes a physical examination for localized abdominal tenderness, often in the lower left quadrant, and assessment of symptoms like fever or nausea. They may order preliminary laboratory tests, such as a complete blood count, to check for an elevated white blood cell count, which suggests infection.
If symptoms are mild and the patient is otherwise healthy, the PCP may initiate outpatient management, recommending a clear liquid diet and sometimes oral antibiotics. The PCP’s primary function is to triage the patient, determining if the case is manageable at home or requires immediate specialist referral or hospital admission. Patients with signs of severe pain, peritonitis, or sepsis are directed to an Emergency Room (ER) for rapid stabilization.
In the ER, emergency medicine physicians manage acute, complicated episodes, such as those involving perforation or obstruction. They utilize imaging, most commonly a Computed Tomography (CT) scan, which is the standard for diagnosis and determining the severity of inflammation, including the presence of abscesses or fistulas. Once the patient is stabilized and the diagnosis confirmed, the ER team coordinates with specialists for definitive care.
Specialized Medical Management
The Gastroenterologist leads the medical and non-surgical management of diverticulitis. This specialist confirms the diagnosis and determines the extent of the disease using advanced imaging techniques. CT scan results, which reveal inflammatory changes, guide the gastroenterologist’s treatment plan.
For hospitalized patients, the gastroenterologist oversees treatment using intravenous (IV) fluids and broad-spectrum IV antibiotics to target the bacteria causing the infection. They monitor the patient’s response to this conservative management, assessing for clinical improvement. If a localized abscess is detected, the gastroenterologist may coordinate with an interventional radiologist to perform a CT-guided percutaneous drainage procedure, potentially avoiding immediate surgery.
After the acute episode resolves, the gastroenterologist recommends a colonoscopy, typically four to eight weeks later. This procedure examines the colon lining to assess the extent of the diverticular disease and rule out serious conditions like colorectal cancer. The gastroenterologist also advises the patient when medical management has been exhausted and surgery should be considered, often after multiple recurrent attacks or complications like a fistula.
Surgical Intervention
When medical management fails or a complication presents an immediate threat, a Colorectal Surgeon or General Surgeon becomes the primary specialist. Colorectal Surgeons possess specialized training in conditions affecting the colon, rectum, and anus, making them highly qualified to perform complex intestinal resections. Surgery is reserved for complicated cases, including:
- Free perforation of the colon
- Obstruction
- Uncontrolled bleeding
- Formation of a fistula
The most common intervention is a bowel resection, specifically a sigmoid colectomy, where the diseased segment is removed. In a primary anastomosis, the surgeon removes the inflamed section and then reconnects the two healthy ends of the colon, allowing for normal bowel function post-recovery. This is often the goal for elective surgeries performed to prevent recurrence.
In emergency situations involving significant infection or peritonitis, the surgeon may perform a Hartmann’s procedure. This two-stage surgery involves removing the diseased segment and creating a temporary colostomy, allowing the rest of the colon to heal. The choice of procedure depends heavily on the level of inflammation and contamination present during the operation.
Ongoing Recovery and Lifestyle Guidance
Post-treatment, whether medical or surgical, the recovery phase focuses on preventing future episodes, and the Primary Care Physician (PCP) resumes a central role in routine follow-up. The PCP monitors the patient’s overall health, manages long-term effects, and reinforces necessary lifestyle modifications that are fundamental to preventing recurrence.
The Registered Dietitian (RD) is a key non-physician team member who provides specific guidance on dietary changes. The dietitian helps transition the patient from acute phase diets back to normal eating. Long-term, the RD guides the patient toward a high-fiber diet, recommending 25 to 35 grams of fiber daily, primarily through fruits, vegetables, and whole grains, along with adequate fluid intake. This strategy helps soften stool, reduce pressure within the colon, and lowers the risk of future flares.