Fast Five Quiz: Diverticulitis and Diverticulosis

B.S. Anand, MD

Disclosures

July 01, 2020

The diagnosis of acute diverticulitis can usually be made on the basis of the history and physical examination. Laboratory testing may be helpful when the diagnosis is in question. A hemogram may reveal leukocytosis and a left shift, indicating infection. However, the absence of leukocytosis does not rule out diverticulitis. This is particularly true in patients who are immunocompromised, older, and have less severe disease.

If a colovesical fistula is suspected, a urinalysis may reveal red or white blood cells. However, inflammation and infection due to diverticulitis adjacent to the ureters or the bladder may be the source of these cells. Urine culture results may confirm sterile pyuria due to inflammation versus polymicrobial infection in the case of a fistula.

Although the diagnosis of diverticulitis can be made on clinical grounds, a CT scan of the abdomen is considered the best imaging method to confirm the diagnosis. CT scans are preferred over intraluminal examinations (eg, barium enema) because the bulk of the inflammation is extraluminal. CT scans can help clinicians assess disease severity, the presence of complications, and clinical staging. Possible CT scan findings include pericolic fat stranding due to inflammation, colonic diverticula, bowel wall thickening, soft tissue inflammatory masses, phlegmon, and abscesses. Peritonitis, fistula formation, and obstruction can also be assessed. In addition, CT scanning can be used to guide percutaneous drainage of an abscess.

Barium contrast enema is not the imaging modality of choice during an acute episode of abdominal pain. It should only be considered in mild to moderate, uncomplicated cases of diverticulitis when the diagnosis is in doubt or for follow-up evaluation for a suspected fistula.

Read more about the workup of diverticulitis.

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