Diverticulitis of the colon is a condition that arises from inflammation of diverticula, which are outpouchings of mucosa and submucosa through weaknesses in the intestinal wall. These are symptomatic in only a minority of patients, and an even smaller minority develop diverticulitis [1] [2]. The occurrence of diverticula, and therefore diverticulitis, is thought to be related to lifestyle [3].

Clinical features and severity vary, and are dictated by the extent and location of the inflammation. Left lower quadrant pain and other gastrointestinal complaints such as nausea, vomiting, change in bowel habits, a loss of appetite, and fever may occur. Inflammation may progress to a localized abscess. The symptoms of colonic diverticulitis may be mistaken for other conditions that present similarly, including acute appendicitis, and certain renal and gynecological conditions.

Occasionally, urinary complaints such as dysuria and frequency may be reported. Macroperforations of the diverticula may occur, leading to peritonitis and possibly abscess formation in the thigh in cases of retroperitoneal perforations. An additional complication of diverticulitis of the colon is fistula formation with the bladder or vagina. Therefore these patients will present with additional signs of fistulae, such as fecaluria and a foul smelling vaginal discharge.

Some patients may experience a sub-acute disease course, with recurrent episodes of abdominal pain and decreased quality of life. In contrast, minimal clinical signs are present in those exposed to exogenous steroids, as well as in older patients.

• Inflammation

  Computed tomography and cystoscopy of the granulomatous mass caused by the inflammation suggested a colon or bladder cancer. A transurethral biopsy from the tumor was therefore performed at first, but showed only inflammation. [ncbi.nlm.nih.gov]

  Clinical features and severity vary, and are dictated by the extent and location of the inflammation. [symptoma.com]

  Diverticulitis is inflammation and/or infection of a diverticulum. Inflammation remains localized in about 75% of patients; the remainder develop abscesses, peritonitis, bowel obstruction, or fistulas. [msdmanuals.com]

• Fever

  A 75-year-old man with no relevant medical history visited our hospital complaining of a fever, which had lasted for 2 weeks. [ncbi.nlm.nih.gov]

  Symptoms Diverticulitis typically causes pain, tenderness, and fever, but unlike diverticulosis, diverticulitis does not generally cause gastrointestinal bleeding. [reliawire.com]

  Fever. Abdominal tenderness. Constipation or, less commonly, diarrhea. When to see a doctor Get medical attention anytime you have constant, unexplained abdominal pain, particularly if you also have fever and constipation or diarrhea. [mayoclinic.org]

  These can cause digestive problems, pain, fever, bleeding, constipation or diarrhea and more. The formation of diverticulosis is common as people get older; but diverticulitis occurs in only a small number of people with diverticulosis. [rochestercolon.com]

  DO watch for signs of diverticulitis and complications, such as abdominal pain and fever. DO call your health care provider if you have a fever or abdominal pain or your pain becomes worse. DON’T strain with bowel movements. DON’T use laxatives. [spectrumhealth.org]

• Chills

  You may experience significant left, lower abdominal pain with additional symptoms of fever, chills, nausea, vomiting and change in bowels. Uncomplicated cases of diverticulitis can be treated with antibiotics and bowel rest. [dhat.com]

  The symptoms of diverticulitis include painful cramps or tenderness in the lower abdomen, and chills or fever. What are the complications of diverticulitis? Serious complications can occur as a result of diverticulitis. [my.clevelandclinic.org]

  Diverticulitis : This occurs when the openings of diverticula in the wall colon are blocked by waste and become infected, causing severe pain and tenderness in the abdomen, possibly coupled with chills and fever. [colorectalconsultants.com]

  However, inflammation of diverticuli, resulting in diverticulitis, typically yield a left lower quadrant abdominal pain as well typical signs of infection such as fever, chills, and anorexia. [pathwaymedicine.org]

  You may also have fever, nausea, vomiting, chills, cramping, and constipation. In serious cases, diverticulitis can lead to bleeding, tears, or blockages. Your doctor will do a physical exam and imaging tests to diagnose it. [medlineplus.gov]

• Abdominal Pain

  The patients individually recorded their body temperature, grade of abdominal pain, number of times that analgesics were used, and number of stools daily. We checked whether the patients had adverse reactions such as abdominal pain or diarrhea. [ncbi.nlm.nih.gov]

  We report an unusual presentation of preoperative abdominal pain during routine bowel preparation. [internationalsurgery.org]

  Further tests are carried out to exclude other possible causes of abdominal pain, while monitoring for complications. These may consist of liver function tests, urinalysis, and urine microscopy and culture. [symptoma.com]

  CT is the most frequently used diagnostic method in patients with abdominal pain. [synapse.koreamed.org]

  Conclusions: Acute diverticulitis should remain on the differential for right-sided abdominal pain. [sages.org]

• Constipation

  CONSTIPATION What is constipation? Constipation is a symptom that has different meanings to different individuals. [ccrcfw.com]

  Fiber softens the stool and helps prevent constipation. It also can help decrease pressure in the colon and help prevent flare-ups of diverticulitis. [ucsfhealth.org]

  When diverticulosis is accompanied by abdominal pain, bloating or constipation, your doctor may recommend a high-fiber diet to help make stools softer and easier to pass. [asge.org]

  Eating more fiber helps stop constipation. Constipation is the main cause of greater pressure in your colon. When you are constipated, your muscles strain to move stool that is too hard. [hopkinsmedicine.org]

  Diets low in fiber cause stool to be harder, and can lead to constipation. Constipation can cause repeated straining during bowel movements, and can increase the pressure in the colon, which can lead to the formation of diverticula. [onhealth.com]

• Nausea

  Left lower quadrant pain and other gastrointestinal complaints such as nausea, vomiting, change in bowel habits, a loss of appetite, and fever may occur. Inflammation may progress to a localized abscess. [symptoma.com]

  The patient had been ill for five days with nausea, vomiting, and abdominal pain, particularly in the right upper quadrant. From the [jamanetwork.com]

  Nausea is common after surgery. Be sure to take your pain medication on a full stomach. Stick to a soft, bland diet for the first few weeks after surgery. If necessary, call your doctor for prescription medication to aid with nausea. [oregonsurgical.com]

  More specifically, she did not describe any abdominal pain, nausea, vomiting, or change in her bowel habits. [internationalsurgery.org]

  Nausea and vomiting. Fever. Abdominal tenderness. Constipation or, less commonly, diarrhea. [mayoclinic.org]

• Vomiting

  Symptoms • 80 to 90% of patients are asymptomatic • One of the main symptoms include upper abdominal pain, right upper quadrant tenderness • Often accompanied by a sense of fullness or discomfort, and may have nausea, vomiting, or vomiting • Symptoms [slideshare.net]

  Left lower quadrant pain and other gastrointestinal complaints such as nausea, vomiting, change in bowel habits, a loss of appetite, and fever may occur. Inflammation may progress to a localized abscess. [symptoma.com]

  The patient had been ill for five days with nausea, vomiting, and abdominal pain, particularly in the right upper quadrant. From the [jamanetwork.com]

  When food is unable to pass through the small intestine or when the body is unable to absorb necessary vitamins, you may experience a number of symptoms: abdominal cramping nausea constipation vomiting acid reflux weight loss bloody stools In most cases [healthline.com]

  Fever Nausea Vomiting Chills Constipation (less often, diarrhea) If diverticulitis is not treated promptly it can develop some very serious complications. [emedicinehealth.com]

• Diarrhea

  We checked whether the patients had adverse reactions such as abdominal pain or diarrhea. RESULTS: No patients experienced serious adverse reactions. One patient had moderate abdominal pain and diarrhea soon after daiobotampito intake. [ncbi.nlm.nih.gov]

  Diarrhea and malabsorption due to bacterial overgrowth can occur if multiple diverticula are present. Duodenal obstruction is extremely rare. [merckmanuals.com]

  When symptoms occur, the clinical signs include [2] : chronic diverticular pain rectal bleeding obstipation small feces episodic diarrhea Diagnostics [ ✎ edit | edit source ] Diverticulosis in endoscopy image. [wikilectures.eu]

  Signs and Symptoms Diverticulosis usually does not cause signs or symptoms, but if any do occur, they can include abdominal cramping, constipation or diarrhea, and bloating. [fortherecordmag.com]

  Constipation or, less commonly, diarrhea. When to see a doctor Get medical attention anytime you have constant, unexplained abdominal pain, particularly if you also have fever and constipation or diarrhea. [mayoclinic.org]

• Dysuria

  A 63-year-old woman was referred to our department with the complaints of dysuria, turbid and foul smelling urine. She was treated twice for acute cystitis at the referral hospitals. A diagnosis of colovesical fistula was confirmed on barium enema. [ncbi.nlm.nih.gov]

  Occasionally, urinary complaints such as dysuria and frequency may be reported. Macroperforations of the diverticula may occur, leading to peritonitis and possibly abscess formation in the thigh in cases of retroperitoneal perforations. [symptoma.com]

  […] sigmoid colon (lower part of the large intestine) due to scarring High risk of serious complications Persistent tender mass in the abdomen May be cancer Endoscopy or x-rays showing suspicious changes in the sigmoid colon May be cancer Pain when urinating (dysuria [merckmanuals.com]

  Moderate 15 Yagi et al[19] 2014 73/M Hematuria Yes Yes Cancer Sigmoid Sigmoidectomy, total resection of the urinary bladder T4bN0M0 Well 16 Nomi et al[20] 2014 64/F Anemia Yes No Bulky tumor Transverse Right hemicolectomy T4bN0M0 Well 17 Our case - 76/M Dysuria [wjgnet.com]

  Patient 1 A 61-year-old woman presented to the emergency department complaining of nausea, acute abdominal pain radiating from her right upper quadrant to her groin, and dysuria. She was afebrile, and her vital signs were stable. [ajronline.org]

• Pelvic Pain

  Pelvic floor dysfunction is a group of disorders that change the way people have bowel movements and sometimes cause pelvic pain. [fascrs.org]

  A pelvic exam should be performed in women to evaluate potential gynecologic causes of pain. A rectal exam may reveal tenderness. Frank blood in the stool is uncommon. [ncbi.nlm.nih.gov]

• Dyspareunia

  […] of the biliary tree on imaging Urinary tract disorders Flank or back pain that radiates to the genitals; dysuria, hematuria Urinalysis with active sediment Gynecologic disorders Acute onset of pelvic pain; menstrual irregularities; vaginal discharge; dyspareunia [ncbi.nlm.nih.gov]

The workup for diverticulitis includes:

• Patient history.
• Physical examination: This will elicit localized abdominal tenderness, abdominal distension, reduced bowel sounds and possibly an abdominal mass in cases of abscess formation. An acute abdomen due to peritonitis is another possible finding, presenting with generalized tenderness.
• Biochemical studies: Findings include a raised white cell count, low red cell count (this occurs when there is gastrointestinal bleeding), electrolyte imbalance and renal dysfunction. Further tests are carried out to exclude other possible causes of abdominal pain, while monitoring for complications. These may consist of liver function tests, urinalysis, and urine microscopy and culture.
• Ultrasound: This can be conducted with a barium enema. Barium enemas and similar investigations, however, are limited in their usefulness as they cannot adequately assess extraluminal processes, whereas diverticulitis displays mostly extraluminal inflammation.
• Computerized tomography (CT) scanning: CT has a high sensitivity and specificity for diverticulitis, and is the preferred imaging modality [4] [5] [6]. In some cases, it is difficult to distinguish between diverticulitis and other abdominal causes of inflammation, even with CT scanning [7]. Typically, diverticulitis of the colon is indicated by thickening of the bowel wall, as well as by fat stranding. Complications such as fistulae, abscesses, hemorrhage, and intestinal obstruction can also be visualized.

• Pneumoperitoneum

  […] quadrant which is producing compression on the barium-filled sigmoid (red arrow), and there is evidence of extraluminal contrast (red arrow) from a perforated diverticulum, Conventional Radiography Sentinel loop or, less likely, LBO Air bubbles in abscess Pneumoperitoneum [learningradiology.com]

  Plain X-ray of the abdomen showed air under the diaphragm (pneumoperitoneum). The chest X-ray was normal. Ultrasonography of the abdomen showed free fluid in the abdomen. [saudijgastro.com]

  […] abscess formation fistula formation bladder: colovesical fistula vagina: colovaginal fistula bowel: coloenteric fistula or colocolic fistula skin: colocutaneous fistula small bowel obstructions from adhesions or bowel wall edema perforation resulting in pneumoperitoneum [radiopaedia.org]

  Intravenous and rectal contrast-enhanced axial CT of the abdomen showing diverticulitis with multiple abscesses (arrow) in the inframesocolic region and pneumoperitoneum, together with generalized peritonitis. [scielo.br]

  The imaging noted evidence of a bowel perforation, with a large pneumoperitoneum and gas seen within the small bowel and sigmoid mesentery (Fig. 1). [internationalsurgery.org]

The abdominal pain of this patient was worse 6 days before treatment, and the pain was almost relieved with initial daiobotampito treatment. CONCLUSIONS: Daiobotampito is a safe treatment option for early stage, acute diverticulitis. [ncbi.nlm.nih.gov]

E.g. the diverticulitis of the right bowel is completely different to that of the left bowel concerning aetiology and treatment. [oparu.uni-ulm.de]

Surgical treatment is warranted for stable patients who do not show rapid improvement with conservative treatment and unstable patients with signs of diffuse peritonitis due to perforation. [dovepress.com]

(See ‘Diverticular disease prognosis’ below.) Diverticulitis — Inflammation of a diverticulum (diverticulitis) occurs when there is thinning of the diverticular wall. [ohiogi.com]

Treatment and prognosis Complications Potential complications include 2, 3 : duodenal diverticulitis hemorrhage perforation abscess formation biliary duct obstruction - Lemmel syndrome The major consideration and mimic of a duodenal diverticulum is that [radiopaedia.org]

Prognosis is worse for individuals who have other medical problems, particularly those requiring the use of steroid medications, which increase the chances of developing a serious infection. Prognosis is also worse in the elderly. [medical-dictionary.thefreedictionary.com]

Keywords Abdominal Abscess/etiology/radiography/surgery — Acute Disease — Adult — Aged — Colectomy — Diverticulitis, Colonic/etiology/radiography/surgery — Female — Humans — Male — Middle Aged — Prognosis — Tomography, X-Ray Computed Identifiers PMID: [archive-ouverte.unige.ch]

[…] differentially in Stages II and III.For patients in Stage II, primary resection is the “elected” procedure, while Stage III usually calls for multi-stage resections, the incontinuity resection of the Hartmann type being the preferred method.Because of poor prognosis [jstage.jst.go.jp]

Its etiology is uncertain, but a congenital origin is widely accepted. Clinically it mimics appendicitis; at operation it is often indistinguishable from carcinoma. Roentgenogram after a barium enema is diagnostic. [ncbi.nlm.nih.gov]

Keywords Abdominal Abscess/etiology/radiography/surgery — Acute Disease — Adult — Aged — Colectomy — Diverticulitis, Colonic/etiology/radiography/surgery — Female — Humans — Male — Middle Aged — Prognosis — Tomography, X-Ray Computed Identifiers PMID: [archive-ouverte.unige.ch]

The etiology is not clearly understood, but it is thought that obesity, low fiber diet, and advanced age are predisposing factors. [symptoma.com]

In cases of complicated diverticular disease, where a colonic fistula is present, a colonoscopy can confirm the site and etiology of the fistula. [clevelandclinicmeded.com]

This review appraises existing evidence on the epidemiology and mechanisms of perforation, highlights areas of further study, and suggests an epidemiological approach towards preventing the condition. [pmj.bmj.com]

抄録 The recent sharp increase in the number of people with diverticular disease, particularly in the Western industrial nations, necessitates the analysis of all epidemiological, pathogenetical, anatomical, and pathophysiological parameters of the disease.A [jstage.jst.go.jp]

National Cancer Institute’s Surveillance Epidemiology and End Results database as of January 1, 2008, as the numerator (16). [pubs.rsna.org]

Such discrepancy could be referred to the highly heterogeneous study design and setting in the different epidemiologic series. [ekjm.org]

抄録 The recent sharp increase in the number of people with diverticular disease, particularly in the Western industrial nations, necessitates the analysis of all epidemiological, pathogenetical, anatomical, and pathophysiological parameters of the disease.A [jstage.jst.go.jp]

Pathophysiology and pathology [ ✎ edit | edit source ] In diverticular disease, the bowel wall is thicker due to much more elastic tissue between the muscle fibers [2]. [wikilectures.eu]

Review article: The pathophysiology and medical management of diverticulosis and diverticular disease of the colon. Alimentary Pharmacology and Therapeutics. 2015;42:664. Pemberton JH, et al. [mayoclinic.org]

Fiber softens the stool and helps prevent constipation. It also can help decrease pressure in the colon and help prevent flare-ups of diverticulitis. [ucsfhealth.org]

Treatment after recovery from an attack of diverticulitis is aimed at preventing another attack. [reliawire.com]

These activities encourage regular bowel activity and help prevent constipation. [livestrong.com]

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7. Ben Yaacoub I, Boulay-Coletta I, Julles MC, Zins M. CT findings of misleading features of colonic diverticulitis. Insights Imaging. 2011;2(1):69–84.