Diverticular disease

Last reviewed: 25 Aug 2022
Last updated: 31 May 2022

Summary

Definition

History and exam

Key diagnostic factors

  • left lower quadrant abdominal pain
  • leukocytosis
  • fever
  • rectal bleeding
More key diagnostic factors

Other diagnostic factors

  • guarding in left lower quadrant
  • tenderness in left lower quadrant
  • bloating
  • constipation
  • pelvic tenderness on digital rectal exam
  • diffuse abdominal tenderness
  • diarrhea
  • palpable abdominal mass
Other diagnostic factors

Risk factors

  • low dietary fiber
  • diet rich in salt, meat, and sugar
  • age >50 years
  • obesity (BMI >30)
  • nonsteroidal anti-inflammatory drug (NSAID) use
More risk factors

Diagnostic investigations

1st investigations to order

  • CBC with differential
  • CRP
More 1st investigations to order

Investigations to consider

  • CT scan of abdomen
  • blood culture
  • abdominal x-ray
  • abdominal ultrasound (graded-compression)
  • abdominal MRI scan
  • chest x-ray
  • contrast enema
  • colonoscopy
  • sigmoidoscopy
  • angiogram
  • isotope-labeled red blood cell nuclear scan
  • diagnostic laparoscopy/exploratory laparotomy
More investigations to consider

Treatment algorithm

ACUTE

asymptomatic diverticulosis

symptomatic diverticular disease

symptomatic diverticulitis (uncomplicated)

symptomatic diverticulitis (complicated)

ONGOING

recurrent diverticulitis

Contributors

Authors

Mohamed A. Thaha, PhD, FRCS (Gen Surg), PG Cert Hlt Econ

Senior Lecturer & Consultant in Colorectal Surgery

National Bowel Research Centre

Blizard Institute

Barts and The London School of Medicine and Dentistry

Queen Mary University of London

The Royal London Hospital

Barts Health NHS Trust

London

UK

Disclosures

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

London

UK

Disclosures

JDJ declares that he has no competing interests.

Acknowledgements

Dr Mohamed A. Thaha and Dr Jayan D. Jayasinghe would like to gratefully acknowledge Dr Emma Carrington, Ms Kathryn Lynes, Professor Norman S. Williams, and Dr Abbasi Akhtar, the previous contributors to this topic.

Disclosures

EC has received honoraria for teaching, and acts as a consultant for Laborie Medical Management Systems. KL has received funding for a research fellowship from the David Johnston Fellowship through the Royal College of Surgeons of England. NSW is an author of a reference cited in this topic. AA declares that he has no competing interests.

Peer reviewers

Ned Snyder, MD, FACP

Professor of Medicine

Chief of Clinical Gastroenterology and Hepatology

University of Texas Medical Branch

Galveston

TX

Disclosures

NS declares that he has no competing interests.

Nicolas Regenet, MD

Clinic of digestive and endocrine surgery

University Hospital

Nantes

France

Disclosures

NR declares that he has no competing interests.

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