- Incidence: 250.00 cases per 100,000 person-years
- Peak incidence: 70+ years
- Sex ratio: 1:1
- Lack of dietary fibre
- Obesity: especially in younger patients
- Sedentary lifestyle
- NSAID use
- Intermittent abdominal pain: particularly in the left lower quadrant
- Change in bowel habit: constipation or diarrhoea
Patients with acute diverticulitis typically present with an acute onset of:
- Severe abdominal pain in the left lower quadrant: this may be in the right lower quadrant in some Asian patients
- Nausea and vomiting (20-60%): this may be due to ileus or complicated diverticulitis with colonic obstruction
- Change in bowel habit: constipation is more common (seen in 50%) but diarrhoea is also reported (25%)
- Urinary frequency, urgency or dysuria (10-15%): this is due to irritation of the bladder by the inflamed bowel.
- PR bleeding (in some cases).
- Symptoms such as pneumaturia or faecaluria may suggest colovesical fistula while vaginal passage of faeces or flatus may suggest a colovaginal fistula.
- Low grade pyrexia
- Tender LIF: in 20% there will be a tender palpable mass due to inflammation or an abscess
- Possibly reduced bowel sounds
- Guarding, rigidity and rebound tenderness may suggest complicated diverticulitis with perforation
- Lack of improvement with treatment in seemingly uncomplicated diverticulitis may suggest the presence of an abscess.
- FBC: raised WCC
- CRP: raised
- Erect CXR: may show pneumoperitoneum in cases of perforation
- AXR: may show dilated bowel loops, obstruction or abscesses
- CT: this is the best modality in suspected abscesses
- Colonoscopy: should be avoided initially due to increased risk of perforation in diverticulitis
- mild cases of acute diverticulitis may be managed with oral antibiotics, liquid diet and analgesia
- if the symptoms don't settle within 72 hours, or the patient intiially presents with more severe symptoms, the patient should be admitted to hospital for IV antibiotics