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2591 pages added, reviewed or updated during the last month (last updated: 16/4/2021)

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clinical features of acute diverticulitis

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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

  • 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
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
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


  • 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.


Last edited 01/2020 and last reviewed 01/2020