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Clinical features of acute diverticulitis

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

Symptoms and signs of acute diverticulitis


Suspect acute diverticulitis if a person presents with constant abdominal pain, usually severe and localising in the left lower quadrant, with any of the
following:

  • fever or
  • sudden change in bowel habit and significant rectal bleeding or passage of mucus from the rectum or
  • tenderness in the left lower quadrant, a palpable abdominal mass or distention on abdominal examination, with a previous history of diverticulosis or diverticulitis
  • Be aware that in a minority of people and in people of Asian origin, pain and tenderness may be localised in the right lower quadrant

Symptoms and signs of complicated acute diverticulitis


Suspect complicated acute diverticulitis and refer for same-day hospital assessment if the person has uncontrolled abdominal pain and any of the
features in table below.

Symptom or sign

Possible Complication

Abdominal mass on examination or peri-rectal fullness on digital rectal examination

Intra-abdominal
abscess

Abdominal rigidity and guarding on examination

Bowel perforation
and peritonitis

Altered mental state, raised respiratory rate, low systolic blood pressure, raised heart rate, low tympanic temperature, no urine output or skin
discolouration

Sepsis

Faecaluria, pneumaturia, pyuria or the passage of faeces through the vagina

Fistula into the
bladder or vagina

Colicky abdominal pain, absolute constipation (passage of no flatus or stool), vomiting or abdominal distention

Intestinal obstruction

Notes:

  • the patient often has along history of painful diverticular disease, flatulence, distension and left iliac fossa pain
  • rectal examination may cause pain as the finger is pushed high into the left side of the pelvis, especially if the inflamed colon is lying in the pelvis. The same also holds true for sigmoidoscopic examination of the recto-sigmoid junction.

Reference:

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