The commonest presenting symptom of diverticulitis is pain. Pain is usually left sided in the left lower quadrant region because this is the most common site for diverticula formation. Fever and other signs of systemic infection may be present if the disease progresses and leads to formation of localized abscess.

Other symptoms are:

• Nausea
• Vomiting
• Change in bowel habit
• Constipation
• Increased flatulence
• Diarrhea
• Bloated feeling [5]
• Bleeding 

The disease could mimic various types of gastrointestinal conditions because of the ability of diverticulosis to occur anywhere along the tract. On physical examination, there is:

• Localized abdominal tenderness in affected area
• If there is an abscess, a tender mass may be felt

• Pain

  If cramps, bloating, and constipation are problems, the doctor may prescribe a short course of pain medication. However, some pain medications actually cause constipation. [gastroenterologistpaloalto.com]

  If you have had recurrent episodes of abdominal pain, especially left lower quadrant abdominal pain, you may have experienced episodes of diverticulitis. [sassesurgical.com]

  This causes the pain associated with diverticulitis and can also lead to further complications such as the formation of an abscess or fistula. [news-medical.net]

  It begins with a pinching pain in the left lower abdomen. Around the pelvic bone and sometimes a little beneath, a throbbing and painful sensation begins to build. This pain can even extend into the lower back. [bodyecology.com]

  Symptoms include pain (usually in the lower left abdomen), fever and chills. Left untreated, it can worsen and may lead to abscesses, or bowel obstruction. [radiologyinfo.org]

• Fever

  "If there is no fever, the preferred treatment is to manage minor attacks with rest, plenty of liquids, and non-narcotic pain medications," says Dr. Goldberg. [health.harvard.edu]

  However, more severe cases result in fevers, chills, severe abdominal pain, and vomiting. In fact, they can be life threatening due to peritonitis and sepsis. [sassesurgical.com]

  See your doctor immediately if you have: very severe abdominal pain a fever start vomiting feel very unwell have blood in your poo Diverticulitis diagnosis To diagnose diverticulitis, your doctor will talk to you and examine you. [healthdirect.gov.au]

  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.com]

• Chills

  Its symptoms are pain and tenderness in the lower left side of the abdomen, chills, and sometimes fever. The presence of diverticulitis can be determined by X rays or computed tomography (CT) scans. [britannica.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]

  Also call if you have diverticulitis and you have: Blood in your stools Fever above 100.4°F (38°C) that does not go away Nausea, vomiting, or chills Sudden belly or back pain that gets worse or is very severe [account.allinahealth.org]

  Symptoms include pain (usually in the lower left abdomen), fever and chills. Left untreated, it can worsen and may lead to abscesses, or bowel obstruction. [radiologyinfo.org]

  If the tissue becomes infected, people may get fever or chills. During a diverticulitis attack, you should eat simple, easily digested foods while symptoms persist. [livestrong.com]

• Sepsis

  At the most severe end of the spectrum, the abscess can rupture and stool may enter the abdominal cavity, which may result in sepsis, a dangerous blood infection. [nytimes.com]

  It can lead to severe complications such as hepatic abscess, sepsis, peritonitis, bowel ischemia, etc., which increase the mortality rate. [ncbi.nlm.nih.gov]

  "An interesting question, and one that historically, we would have answered with: 'catastrophe,' including potential perforation, abscess in the abdomen, sepsis and even death. [livescience.com]

• Swelling

  Doctors give antibiotics by vein in the hospital if the pain, tenderness and swelling are severe. In fact, swelling can cause a blockage of the colon. Infected diverticuli can rupture. Such a condition requires surgery. [ddc.musc.edu]

  A 41-year-old man was admitted to our hospital because of redness and swelling of the left inguinal skin. Enhanced abdominal CT revealed a subcutaneous abscess in the left lower abdomen. [ncbi.nlm.nih.gov]

  Diverticulitis occurs when there is inflammation (swelling) and infection in one or more diverticula. This usually happens when these outpouchings become blocked with waste, allowing bacteria to build up and causing infection. [my.clevelandclinic.org]

  This may be caused by hard pieces of stool that increase pressure within the diverticulum leading to thinning of its wall and swelling/inflammation. SYMPTOMS Diverticulosis is asymptomatic in the majority of patients. [asge.org]

  Diverticulitis is an infection or swelling in this pouch. Diverticulitis Infected pouches along the colon. Copyright © Nucleus Medical Media, Inc. Causes Digested food or stool can become trapped in one of the pouches. [winchesterhospital.org]

• Sore Throat

  When CMV is first contracted it might cause symptoms similar to the flu (fever, sore throat, fatigue, swollen lymph nodes) but then it may go into an inactive stage. The virus stays in the body, latent. [verywellhealth.com]

  –#. aasta keskmine kogurahvatulu elaniku kohta (ostujõu standardi alusel) on # % või suurem ja väiksem kui # % #liikmelise ELi keskmisest: #,# % nende SKTst en Other signs and symptoms may include respiratory signs and symptoms such as dyspnoea, sore [glosbe.com]

  STEP 2: Supplements to Treat Diverticulitis Slippery Elm Native Americans have used slippery elm for centuries both externally and internally to soothe digestive problems and relieve coughs and sore throats. [draxe.com]

• Pharyngitis

  […] chest x-ray findings (predominantly infiltrates, which can be localised), gastrointestinal symptoms, such as nausea, vomiting, diarrhoea, or abdominal pain, and may lead to misdiagnosis of hypersensitivity as respiratory disease (pneumonia, bronchitis, pharyngitis [glosbe.com]

• Abdominal Pain

  If you have had recurrent episodes of abdominal pain, especially left lower quadrant abdominal pain, you may have experienced episodes of diverticulitis. [sassesurgical.com]

  Physicians should be aware of their existence and the clinical suspicion should be raised, especially in the setting of acute abdominal pain where jejunal diverticulitis should be included in the differential diagnosis. [ncbi.nlm.nih.gov]

  Severe abdominal pain is a common complaint encountered by primary care and emergency room physicians. Caused by many conditions, including appendicitis and diverticulitis, severe abdominal pain may be a diagnostic challenge. [dx.doi.org]

• Constipation

  You ask about the use of charcoal for diverticulosis: because constipation figures so prominently in the formation of diverticula, and because charcoal tends to be binding or constipating for many, I would choose to focus more on lifestyle issues than [charcoalremedies.com]

  The formation of a diverticulum begins with constipation. As the muscles of the large intestine contract to move hard stool, pressure levels inside the colon increase. [drdalepeterson.com]

  Digested material passes more quickly through the gut which decreases the chance of constipation. Insoluble fiber from grains and vegetables produces feces that is easier to pass. [livestrong.com]

  When this occurs, there may be thin or pellet-shaped stools, constipation, and an occasional rush of diarrhea. The problem then becomes a mechanical or structural one, and treatment is more difficult. [gicare.com]

• Nausea

  Patients with the sacs can tell if there is inflammation through pain in the lower left side of the abdomen, fevers, nausea and irregular bowel movements. [wrvo.org]

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

  Diverticulitis symptoms may include extreme abdominal pain, commonly in the left lower quadrant, as well as nausea, vomiting or diarrhea. [livestrong.com]

  Also call if you have diverticulitis and you have: Blood in your stools Fever above 100.4°F (38°C) that does not go away Nausea, vomiting, or chills Sudden belly or back pain that gets worse or is very severe [account.allinahealth.org]

• Vomiting

  See your doctor immediately if you have: very severe abdominal pain a fever start vomiting feel very unwell have blood in your poo Diverticulitis diagnosis To diagnose diverticulitis, your doctor will talk to you and examine you. [healthdirect.gov.au]

  In addition, nausea, vomiting, diarrhea, or constipation are symptoms that may occur. In moderate to severe symptoms a person has more severe pain, can't keep any liquids down, and may have a fever. [nationaljewish.org]

  Also seek medical attention if you have a fever, the pain gets worse, and you have consistent vomiting or lack of bowel movements. [diet.lovetoknow.com]

  Blood chemistry to examine the levels of electrolytes in patients who have been vomiting. [symptoma.com]

  Diverticulitis symptoms may include extreme abdominal pain, commonly in the left lower quadrant, as well as nausea, vomiting or diarrhea. [livestrong.com]

• Rectal Bleeding

  One of these complications is rectal bleeding, also called diverticular bleeding. Diverticular bleeding occurs when there is chronic (long-term) injury to the small blood vessels near the diverticula. The other complication is diverticulitis. [my.clevelandclinic.org]

  We describe a 9-year-old boy with Williams syndrome who presented with rectal bleeding secondary to sigmoid diverticulitis. This case represents the youngest known patient with diverticulitis. [ncbi.nlm.nih.gov]

  Image Credit: Designua / Shutterstock Symptoms Some of the symptoms of diverticulitis include: Intermittent stomach pain Abdominal bloating High fever of 38ºC (100.4ºF) or above Rectal bleeding Diarrhea and constipation Causes and pathology Diverticula [news-medical.net]

  Most people with diverticulosis don't have any symptoms from the condition unless they develop one of two complications: either rectal bleeding or inflammation, called diverticulitis. [sharecare.com]

• Back Pain

  Also call if you have diverticulitis and you have: Blood in your stools Fever above 100.4°F (38°C) that does not go away Nausea, vomiting, or chills Sudden belly or back pain that gets worse or is very severe [account.allinahealth.org]

  Also call if you have diverticulitis and you have: Blood in your stools Fever above 100.4°F (38°C) that does not go away Nausea, vomiting, or chills Sudden belly or back pain that gets worse or is very severe Images References Bhuket TP, Stollman NH. [ufhealth.org]

  Also call if you have diverticulitis and you have: Blood in your stools Fever above 100.4°F (38°C) that does not go away Nausea, vomiting, or chills Sudden belly or back pain that gets worse or is very severe References Bhuket TP, Stollman NH. [mountsinai.org]

  Also call if you have diverticulitis and you have: Blood in your stools Fever above 100.4°F (38°C) that does not go away Nausea, vomiting, or chills Sudden belly or back pain that gets worse or is very severe Bhuket TP, Stollman NH. [nlm.nih.gov]

• Confusion

  A small amount of free air adjacent to the small bowel can be confusing and easily misdiagnosed as small bowel perforation, but, it can actually be found as a result of the inflammation itself without macroperforation or complications.This fact can change [ncbi.nlm.nih.gov]

  Jaggers comments: People confuse diverticulitis and diverticulosis. Diverticulosis is when you have those pouches in the colon. They don’t cause symptoms and most of us have it as we age. [mcleodhealth.org]

  It is also important not to confuse the symptoms of this illness with other syndromes that can cause similar lower abdominal pain, like appendicitis, colon cancer, ovarian cancer and ectopic pregnancy among others. [gastrohealth.com]

  Sometimes it is hard and confusing to me but I am really trying because it is working. My brother asked, are you going to eat like this for the rest of your life? and I said YES. [diverticulitispainfreefoods.com]

• 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]

  […] and acute pain Schwerk (1992) Dis Colon Rectum 35(11): 1077-84 [PubMed] Consider in women for evaluating additional Pelvic Pain causes (including pregnancy-related) Avoid Colonoscopy in acute disease Risk of worsening perforation Avoid Barium Enema in [fpnotebook.com]

Laboratory tests

They are used when the history and physical examination are inconclusive. They include:

• Complete blood count will show increased white blood cell count and reduced hemoglobin if bleeding is present.
• Blood chemistry to examine the levels of electrolytes in patients who have been vomiting.
• Renal function [6]
• Test for liver function and liver enzymes 
• Blood culture should be obtained before instituting antibiotics
• Pregnancy test  to rule out other conditions like extra-uterine pregnancy in a woman of childbearing age
• Urinalysis
• Urine culture

Imaging

• CT scan, when necessary, this is the imaging study of choice. Findings include inflammatory masses and bowel wall thickening.
• Contrast studies: Barium us contraindicated as there may be perforations and leakage of contrast into the peritoneal cavity could be disastrous. A water soluble contrast medium is preferred when a CT scan can’t adequately differentiate colon cancer from diverticulitis.
• Plain radiographs have no use in diagnosing this condition but may demonstrate associated obstruction and bowel perforation [7].
• Colonoscopy can be used after an acute episode to check the extent of the diverticulosis.

• Colonic Stricture

  Over time, milder, but repeated attacks of diverticulitis can form a tight narrowing of the colon (“colonic stricture”) that produces pain and a blockage, also requiring surgery. At times diverticulosis can result in severe hemorrhage and anemia. [sassesurgical.com]

  Possible Complications More serious problems that may develop are: Abnormal connections that form between parts of the colon or between the colon and another part of the body (fistula) Hole or tear in the colon (perforation) Narrowed area in the colon [account.allinahealth.org]

  A colonic stricture or fistula. A history of multiple attacks may result in a patient deciding to undergo surgery to prevent future attacks. Surgery for diverticular disease usually involves removal of the affected part of the colon. [fascrs.org]

  (stricture) Pocket filled with pus or infection (abscess) Bleeding from the diverticula When to Contact a Medical Professional Call your provider if symptoms of diverticulitis occur. [mountsinai.org]

In patients with the acute uncomplicated type, conservative management achieves full remission in over 70% of cases. Some studies have shown that antibiotics worsen the inflammatory process. Conservative management includes:

• Clear liquid diet
• Resting the bowel
• IV fluids
• Managing the pain

Antibiotics, if used, are broad spectrum to cover aerobic and non-aerobic organisms. This could be a single or multi drug regimen. If diverticulitis is severe, as characterized by peritonitis and systemic signs of infection, hospitalization is required [8].

Surgery is indicated when there is a complication. Complications may include intestinal obstruction, presence of fistula, abscesses and peritonitis. At discharge, patient’s diet should be low in fat and high in fiber.

The following factors may worsen the prognosis:

• Coexisting medical problems
• The presence of complications
• Severity of the illness [4]

The cause if diverticula formation is yet unclear. There is however strong association with obesity, low fiber diet and constipation. When these pouches are present, there are now factors that could lead to inflammation and hence diverticulitis. Although the exact pathway by which diverticulitis occurs is unclear, there have been some postulations [2]:

• Collection of undigested food particles in the diverticulum
• Collection of fecal matter in the diverticulum
• Raised intraluminal pressure 
• Thickened food particles

Diverticulitis is mainly a disease of the elderly although it is now seen in younger age groups as well. The incidence increases with advancing age and 65% of people older than 85 years have diverticulitis. There is no sexual preference as the disease affects both sexes equally.

It is more common in industrialized countries compared to underdeveloped countries. This could be due to lifestyle and diet. It is seen more Caucasians and Asians than in blacks.

There are two ways by which diverticulosis is thought to occur. The first is erosion of the wall of the diverticula which leads to inflammation, necrosis and then perforation.
The second mechanism, which is also touted to be the commonest is obstruction of the diverticulum lumen. This obstruction is usually by undigested food particles or fecal matter. The obstruction then leads to distension due to mucus secretion within the diverticulum. Subsequently, the blood supply is compromised and this will cause perforations, both micro and macro, of the diverticulum[3].

Chronic diverticulitis could lead to fistula formation. Frequent bouts of diverticulitis can also cause intestinal obstruction when it causes scar formation which obstructs the colonic lumen.

In patients with risk for diverticulosis, and in those with asymptomatic types, the standard of prevention is a high-fiber diet [9].

In some people, there is some herniation of mucosa into the wall of the colon. This creates small pouches which are known as diverticula and the condition is known as diverticulosis. When one or more of this pouches get inflamed, it is called diverticulitis. Diverticulitis could be acute or chronic and it includes a wide range of conditions from asymptomatic forms to symptomatic forms [1].

Definition

Diverticulitis is a condition that results from inflammation of diverticula in the intestines. Diverticula are abnormal pouches that form on the walls of the intestines.

Cause

There is no clear cause. However, patients who have a high fiber diet, those who are obese, frequently constipated ones and older people tend to develop these pouches. When this pouches are present, they can be blocked by food or fecal particle which could lead to the processes causing diverticulitis.

Signs and symptoms

The commonest symptom of this disease is abdominal pain. It is usually on the left, like appendicitis but on the other side. Other symptoms include nausea, vomiting, diarrhea, increased flatulence, and constipation amongst others.

Diagnosis

Diagnosis is mainly by history and the examination by the doctor. Some laboratory tests like blood and urine tests may be done to check severity of the disease and the function of some organs in the body. Some imaging tests may also be carried out [10].

Treatment

For the mild type, treatment is conservative and patient may or may not require antibiotics. For the sever type, hospital stay would be necessary for close monitoring and patient may require surgery.

1. Strate LL, Liu YL, Aldoori WH, Syngal S, Giovannucci EL. Obesity increases the risks of diverticulitis and diverticular bleeding. Gastroenterology. Jan 2009;136(1):115-122.e1.
2. Miller FH, Bree RL, Rosen MP, et al. Expert Panel on Gastrointestinal Imaging. ACR Appropriateness Criteria left lower quadrant pain. [online publication]. Reston (VA): American College of Radiology (ACR); 2008
3. Alonso S, Pera M, Pares D, et al. Outpatient treatment of patients with uncomplicated acute diverticulitis.Colorectal Dis. Nov 10 2009
4. Chapman J, Davies M, Wolff B, Dozois E, Tessier D, Harrington J, et al. Complicated diverticulitis: is it time to rethink the rules?. Ann Surg. Oct 2005;242(4):576-81; discussion 581-3.
5. Evans JP, Cooper J, Roediger WE. Diverticular colitis - therapeutic and aetiological considerations.Colorectal Dis. May 2002;4(3):208-212.
6. Oliver G, Lowry A, Vernava A, Hicks T, Burnstein M, Denstman F, et al. Practice parameters for antibiotic prophylaxis--supporting documentation. The Standards Task Force. The American Society of Colon and Rectal Surgeons. Dis Colon Rectum. Sep 2000;43(9):1194-200.
7. Rafferty J, Shellito P, Hyman NH, Buie WD. Practice parameters for sigmoid diverticulitis. Dis Colon Rectum. Jul 2006;49(7):939-44.
8. Ripolles T, Agramunt M, Martinez MJ, Costa S, Gomez-Abril SA, Richart J. The role of ultrasound in the diagnosis, management and evolutive prognosis of acute left-sided colonic diverticulitis: a review of 208 patients. Eur Radiol. Dec 2003;13(12):2587-95
9. Schreyer AG, Furst A, Agha A, Kikinis R, Scheibl K, Scholmerich J, et al. Magnetic resonance imaging based colonography for diagnosis and assessment of diverticulosis and diverticulitis. Int J Colorectal Dis. Sep 2004;19(5):474-80.
10. Ambrosetti P, Robert JH, Witzig JA, Mirescu D, Mathey P, Borst F, et al. Acute left colonic diverticulitis in young patients. J Am Coll Surg. Aug 1994;179(2):156-60.