Diverticular disease may be asymptomatic or may present with non-specific abdominal symptoms, such as pain or tenderness.
Symptomatic acute diverticulitis presents with fever, leukocytosis, and left lower quadrant pain.
Computed tomography scan is the imaging modality of choice for acute diverticulitis and complicated diverticular disease.
Treatment includes bowel rest, antibiotics, and surgical intervention.
Complications include bleeding, infection, segmental colitis, perforation, abscess, peritonitis, fistula, and obstruction.
Diverticular disease may be defined as any clinical state caused by symptoms pertaining to colonic diverticula and includes a wide-ranging spectrum from asymptomatic to severe and complicated disease. Colonic diverticulosis refers to herniation of the mucosa and submucosa through the muscular layer of the colonic wall and may be the result of colonic smooth muscle over-activity. Diverticulitis indicates inflammation of a diverticulum or diverticula and may be caused by infection. Other complications of diverticular disease include segmental colitis, lower gastrointestinal bleeding, infection, abscess, perforation, peritonitis, fistula formation, and obstruction.
History and exam
Key diagnostic factors
- presence of risk factors
- left lower quadrant abdominal pain
- rectal bleeding
Other diagnostic factors
- guarding in left lower quadrant
- tenderness in left lower quadrant
- pelvic tenderness on digital rectal examination
- diffuse abdominal tenderness
- palpable abdominal mass
- age >50 years
- low dietary fibre
- diet rich in salt, meat, and sugar
- obesity (BMI >30)
- non-steroidal anti-inflammatory drug and opioid use
1st investigations to order
- FBC with differential
- urea and electrolytes
- C-reactive protein
Investigations to consider
- contrast CT scan of abdomen
- non-contrast CT scan of abdomen
- abdominal ultrasound (graded-compression)
- chest x-ray
- CT angiogram
- isotope-labelled red blood cell nuclear scan
- diagnostic laparoscopy
- blood culture
- ABG and serum lactate
symptomatic diverticular disease
acute diverticulitis (uncomplicated)
acute diverticulitis (complicated)
Mohamed A. Thaha, PhD, FRCS (Gen Surg), PG Cert Hlt Econ
Senior Lecturer & Lead Consultant in Colorectal Surgery
National Bowel Research Centre
Barts and The London School of Medicine and Dentistry
The Royal London Hospital
Queen Mary, University of London
MAT declares that he has no competing interests.
Jayan Dewanta Jayasinghe, MD
International Senior Fellow in Colorectal Surgery
The Royal London Hospital
Barts Health NHS Trust
JDJ declares that he has no competing interests.
John Abercrombie, FRCS
General and Colorectal Surgeon
Queen’s Medical Centre
JA is a former Clinical Lead for General Surgery, Getting It Right First Time.
JA is a council member of the Royal College of Surgeons of England.
Section Editor, BMJ Best Practice
EQ declares that she has no competing interests.
Lead Section Editor, BMJ Best Practice
RW declares that she has no competing interests.
Comorbidities Editor, BMJ Best Practice
JC declares that she has no competing interests.
Drug Editor, BMJ Best Practice
AM declares that he has no competing interests.
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