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