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K57.4 - Diverticulitis with Perforation & Abscess
K57.4 is an ICD-10 diagnosis code for diverticulitis of the large intestine with perforation and abscess, a serious complication requiring urgent medical treatment.
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K57.4 is an ICD-10 diagnosis code for diverticulitis of the large intestine with perforation and abscess, a serious complication requiring urgent medical treatment.
What Does the ICD-10 Code K57.4 Mean?
The ICD-10 code K57.4 stands for diverticulitis of the large intestine with perforation and abscess. It belongs to the group of diverticular diseases of the intestine (K57) and describes a severe, acute form in which inflamed pouches in the bowel wall (diverticula) rupture or form a pus-filled cavity (abscess).
Background: What Are Diverticula?
Diverticula are small, pouch-like protrusions of the intestinal wall that occur mainly in the large intestine (colon), most commonly in the sigmoid colon. When these pouches become inflamed, the condition is called diverticulitis. Complicated cases such as K57.4 involve a perforation (a hole through the bowel wall) and/or the formation of an abscess (a localized collection of pus in the abdominal cavity).
Causes
The development of diverticula and their subsequent inflammation is influenced by several factors:
- A low-fiber diet and chronic constipation
- Increased pressure within the colon due to insufficient stool bulk
- Advancing age (diverticula are more common in older adults)
- Physical inactivity and obesity
- Genetic predisposition
Symptoms
In complicated diverticulitis as classified under K57.4, the following symptoms may occur:
- Severe abdominal pain, often on the lower left side
- Fever and general malaise
- Nausea and vomiting
- Changes in bowel habits (diarrhea or constipation)
- Abdominal tenderness and guarding (indicating possible peritonitis)
- In severe cases: signs of an acute abdomen
Diagnosis
The following investigations are used to confirm the diagnosis and assess the severity:
- Laboratory tests: Complete blood count, CRP (inflammatory marker), white blood cell count
- CT scan of the abdomen: Gold standard for visualizing abscesses, perforations, and the extent of inflammation
- Ultrasound: Used as an initial imaging tool
- Colonoscopy: Recommended only after the acute phase has resolved
Treatment
Treatment of K57.4 depends on the severity and usually requires inpatient hospital care:
Conservative Treatment
- Antibiotic therapy (e.g., metronidazole combined with cephalosporins)
- Fasting or parenteral nutrition to rest the bowel
- Pain management
Interventional Treatment
- Percutaneous abscess drainage: Image-guided drainage of the abscess through the skin
Surgical Treatment
- Surgical intervention: Emergency surgery is often required in cases of perforation with generalized peritonitis or uncontrollable abscess. The affected bowel segment is typically removed (sigmoid resection).
- A temporary colostomy (artificial bowel opening) may be created as a bridging measure
Prognosis and Outlook
K57.4 represents a medical emergency and must be treated without delay. With early and adequate treatment, the prognosis is generally favorable. If left untreated, the condition can progress to generalized peritonitis or life-threatening sepsis. After recovery, clinical guidelines recommend a follow-up colonoscopy and long-term dietary adjustments to reduce recurrence.
References
- Leifeld L. et al. - S2k-Leitlinie Divertikelkrankheit/Divertikulitis, AWMF Register No. 021-020, Deutsche Gesellschaft für Gastroenterologie (2022).
- World Health Organization (WHO) - International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10), Code K57.4.
- Feingold D. et al. - Practice Parameters for the Treatment of Sigmoid Diverticulitis. Diseases of the Colon & Rectum, 57(3):284-294 (2014).
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