Diverticular disease is usually asymptomatic; patients may have constipation or nonspecific abdominal symptoms.
Symptomatic acute diverticulitis presents with fever, leukocytosis, and left lower quadrant pain.
Colonoscopy is a common diagnostic test for diverticular disease. Computed tomography scan is the imaging modality of choice for acute diverticulitis and complicated diverticular disease, and has largely replaced contrast enema.
Treatment includes bowel rest, analgesics, antibiotics, and surgical intervention.
Complications include bleeding, infection, segmental colitis, perforation, abscess, peritonitis, fistula, and obstruction.
Manage acute bleeding by intravenous fluids or blood transfusion, and radiologically directed hemostasis (embolization).
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. 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. 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
- 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 exam
- diffuse abdominal tenderness
- palpable abdominal mass
- low dietary fiber
- diet rich in salt, meat, and sugar
- age >50 years
- obesity (BMI >30)
- nonsteroidal anti-inflammatory drug (NSAID) use
1st investigations to order
- CBC with differential
Investigations to consider
- CT scan of abdomen
- blood culture
- abdominal x-ray
- abdominal ultrasound (graded-compression)
- abdominal MRI scan
- chest x-ray
- contrast enema
- isotope-labeled red blood cell nuclear scan
- diagnostic laparoscopy/exploratory laparotomy
symptomatic diverticular disease
symptomatic diverticulitis (uncomplicated)
symptomatic diverticulitis (complicated)
- Colorectal cancer
- Diagnosis and management of acute left-sided colonic diverticulitis
- Colonoscopy for diagnostic evaluation and interventions to prevent recurrence after acute left-sided colonic diverticulitis
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