Diverticulitis/Diverticular Disease

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Signs and Symptoms

In most cases, diverticulosis does not cause symptoms. The condition sometimes can result in constipation, mild cramping, and bloating (distension of the abdomen). Symptoms of diverticulitis vary depending on the severity of the condition. They include the following:

• Abdominal pain and tenderness (especially on the lower left side)
• Bleeding from the rectum (usually microscopic)
• Constipation
• Diarrhea
• Fever
• Loss of appetite
• Nausea and vomiting

Diverticulitis may be more severe in younger patients (often due to a delay in diagnosis), in patients who have a compromised immune system, and in patients who have other conditions (e.g., diabetes, kidney disease).

Complications
Acute diverticulitis can cause a number of complications. An abscess is an infected area that can result in swelling, tissue damage, and small tears (perforations) and blockages in the lining of the gastrointestinal tract.

When an abscess develops, pus from the infection can leak into the abdomen, causing the infection to spread into the abdominal cavity. This condition, called peritonitis, is a medical emergency that requires immediate surgery. Spread of the infection to the bloodstream (sepsis) and shock also can occur.

A fistula can develop when an abscess heals. This condition occurs when infected intestinal tissue comes into contact with nearby organs or tissue and heals into an abnormal passage or connection. The most common type of fistula that develops as a result of diverticulitis occurs between the colon and the bladder and can cause severe urinary tract infections (UTIs). Surgery often is performed to remove the fistula.

In some cases, diverticulitis results in scarring that can cause partial or complete blockages in the gastrointestinal tract. Total obstruction requires immediate surgery.

Diagnosis

Diverticulosis often is diagnosed during an evaluation for another condition or during routine tests (e.g., colonoscopy). Colonoscopy and sigmoidoscopy, which involve using a flexible tube with a light and camera to view images of the colon, are not used to diagnose acute diverticulitis due to a risk for tearing or rupture of an inflamed diverticulum.

Diagnosis of diverticulitis involves taking a personal and family medical history, and performing a physical examination, including digital rectal exam (DRE) and diagnostic tests (e.g., laboratory tests, imaging tests). In some cases, other conditions, such as appendicitis, ulcer, or gallbladder disease (e.g., acute cholecystitis) must be ruled out.

Information about the patient's diet, bowel habits, and symptoms, as well as any family history of diverticular disease, may be used to help make a diagnosis. In a digital rectal examination (DRE), the physician inserts a lubricated, gloved finger into the patient's rectum to detect tenderness, blockage, or blood.

Laboratory tests may include blood tests and urinalysis. Elevated levels of white blood cells may indicate infection and a low red blood cell count (anemia) may indicate bleeding in the GI tract. Urinalysis can be used to detect red or white blood cells in the urine, which can indicate diverticulitis. Liver function tests may be performed to rule out other conditions.

When a definitive diagnosis cannot be made on the basis of physical examination and laboratory tests, imaging tests (e.g., x-rays, computed tomography [CT scan], ultrasound) may be performed. Virtual colonoscopy with CT or MRI scan (colonography) is a newer imaging test that may be used. Colonoscopy or barium enema may be performed after acute cases have been successfully treated to rule out other conditions, such as colon cancer.

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