Fast Five Quiz: How Much Do You Know About Diverticulitis?

Jamie Shalkow, MD


May 09, 2016

Diverticulitis can present with a range of physical findings, mirroring the severity of the inflammation and the presence of complications:

  • In simple diverticulitis, localized abdominal tenderness in the area of the affected diverticula and fever are common findings. Left lower-quadrant tenderness is the most common physical finding, because most diverticula occur in the sigmoid colon. Right lower-quadrant tenderness, mimicking acute appendicitis, can occur in right-sided diverticulitis.

  • In complicated diverticulitis with abscess formation, a tender palpable mass may be felt on physical examination. In fact, 20% of cases present with a palpable mass on abdominal, pelvic, or rectal examination. Peritonitis due to free perforation results in generalized tenderness with rebound and guarding on abdominal examination. The abdomen may be distended and tympanic to percussion. Bowel sounds can be diminished or absent.

  • Elderly patients and some patients taking corticosteroids may have unremarkable findings on physical examination, even in the presence of severe diverticulitis. Such patients must be approached with a high index of suspicion to avoid a delay in establishing the correct diagnosis.

  • If a fistula forms, the findings vary depending on the type of fistula. Colovesical fistulae may present with urinary tract symptoms, such as suprapubic, flank, or costovertebral angle tenderness. Fecaluria or pneumaturia can also be observed. Female patients with colovaginal fistulas may present with a purulent vaginal discharge.

For more on the presentation of diverticulitis, read here.


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