diverticulitis (chronic)

Last edited 01/2020 and last reviewed 01/2020

Chronic diverticulits results from inflammation of one or more diverticula.

This condition may exactly mimic the local clinical features of carcinoma of the colon:

  • there may be diarrhoea alternating with constipation which progresses to large bowel obstruction with vomiting, distension, colicky abdominal pain and constipation - note that small bowel obstruction from adhesion of a loop of small intestine to the inflammatory mass is not uncommon.
  • there may be episodes of pain in the left iliac fossa
  • passage of mucus or bright red blood per rectum or melaena
  • anaemia due to chronic occult bleeding. Examination reveals tenderness in the LIF and there is often a thickened mass in the region of the sigmoid colon, which may also be felt on PR

NICE suggest that a clinician should suspect diverticular disease if a person presents with one or both of the following (1):

  • intermittent abdominal pain in the left lower quadrant with constipation, diarrhoea or occasional large rectal bleeds (the pain may be triggered by eating and relieved by the passage of stool or flatus)
  • tenderness in the left lower quadrant on abdominal examination
  • 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 may overlap with conditions such as irritable bowel syndrome, colitis and malignancy