Diverticular disease is a diagnosis of exclusion. Hence, investigation must first rule out other treatable causes of similar symptomatology, e.g. ulcerative colitis, Crohn's disease, ischaemic colitis and colorectal carcinoma.
Classically, barium enema was used as first-line investigations. However CT has now become the standard for diagnosis of diverticular disease (abdomen and pelvis)
Contrast enemas have limited value due to diverticulitis being and extraluminal process. Finding suggestive of a diagnosis include: extravasated contrast material outlining an abscess cavity, intramural sinus tract, or fistula (1).
A chest x-ray with the patient upright may help in detecting pneumoperitonium. An abdominal x-ray may reveal abnormalities such as small or large bowel dilation or ileus, pneumoperitoneum, bowel obstruction, or soft-tissue densities suggesting abscesses. (2)
NICE suggest (3):
A full blood count (FBC), looking for neutrophilia or anaemia, urea and electrolytes, and C-reactive protein.
Non-specific inflammatory markers are often elevated; an initial C-reactive protein concentration above 170 mg/L (17 mg/dL) can predict complicated diverticulitis, although a low C-reactive protein does not rule out complicated diverticulitis. Consider alternative diagnoses if inflammatory markers are not raised.
Do not routinely refer people with suspected diverticular disease unless:
If the person meets the criteria for a suspected cancer pathway, refer by this route
Reference:
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