What are the localized and systemic signs of diverticulitis?

Updated: Aug 06, 2019
  • Author: Elie M Ghoulam, MD, MS; Chief Editor: BS Anand, MD  more...
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A microperforation, most likely walled off by adjacent structures, may present with no systemic signs of illness or infection. However, the disease may progress from a localized and walled-off process to one with peridiverticular inflammatory phlegmon and localized abscess. Systemic signs of infection (eg, fever) then develop.

Diverticulitis can mimic other conditions

Because diverticula and, hence, diverticulitis can develop anywhere in the gastrointestinal tract, symptoms may mimic multiple conditions. Note the following:

  • Diverticulitis in the right colon or in a redundant sigmoid colon may be mistaken for acute appendicitis. Cecal diverticulitis can also mimic acute appendicitis, but cecal diverticula are generally rare. Diverticulitis in the transverse colon may mimic peptic ulcer diseasepancreatitis, or cholecystitis. Retroperitoneal involvement may present similarly to renal disease. In women, lower quadrant pain may be difficult to distinguish from a gynecologic process.

  • More severe diverticulitis is often accompanied by anorexia, nausea, and vomiting. Typically, the pain is localized, severe, and present for several days prior to presentation. An altered bowel habit, especially constipation, is reported by most patients. A small percentage of patients may complain of urinary symptoms, such as dysuria, urgency, and frequency, due to the inflammation adjacent to urinary tract structures.

  • Macroperforation with spillage of colonic contents into the peritoneum can lead to generalized abdominal pain and peritonitis, or it may lead to a localized pelvic, left lower quadrant, or right lower quadrant abscess with more localized abdominal pain and peritonitis.

  • Leg pain possibly associated with a thigh abscess and leg emphysema secondary to retroperitoneal perforation from diverticulitis have been reported.

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