clinical features

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Diverticular disease is often asymptomatic (75-80%) and can be an incidental finding during assessment of a patient for another reason (1).

In uncomplicated symptomatic patients, the following may be present:

  • non-specific abdominal complaints
    • lower abdominal pain
      • usually left sided and colicky, but can be constant
      • may be aggravated by eating and diminished with defecation or flatus (suggests colonic wall tension due to raised pressure inside the bowel)
  • other symptoms such as bloating and constipation may be seen in some patients
  • assessment may reveal fullness or mild tenderness in the lower left quadrant (frank rebound or guarding should be absent) (1)

Complicated diverticular disease

  • acute diverticulitis
    • abdominal pain
      • may present as mild intermittent pain or as chronic severe unrelenting    pain
      • usually left sided (in Asian patients, right lower quadrant pain due to right sided diverticula)
    • change in bowel habits – constipation (in 50%) and diarrhoea (in 25-30%)
    • systemic features such as fever
    • other symptoms
      • nausea, vomiting
      • urinary symptoms – dysuria and increased frequency related to bladder irritation
    • abdominal examination may reveal rigidity, rebound tenderness and guarding (1,2)

The diagnosis is made by the appearance of the bowel on barium enema.

Reference:

  1. Stollman N, Raskin JB. Diverticular disease of the colon. Lancet. 2004;363(9409):631-9
  2. Feuerstein JD, Falchuk KR. Diverticulosis and Diverticulitis. Mayo Clin Proc. 2016 Aug;91(8):1094-104

Last edited 08/2018 and last reviewed 01/2020