By age 50, one third of adults have diverticulosis coli; two thirds have diverticulosis by age 80. Ten to 20% of patients with diverticulosis will have diverticulitis or diverticular hemorrhage. Causes of diverticulosis include aging, elevation of colonic intraluminal pressure, and decreased dietary fiber. Eighty-five percent are found in the sigmoid colon. I. Clinical presentation of diverticulitis

A. Diverticulitis is characterized by the abrupt onset of unremitting left-lower quadrant abdominal pain, fever, and an alteration in bowel pattern. Diverticulitis of the transverse colon may simulate ulcer pain; diverticulitis of the cecum and redundant sigmoid may resemble appendicitis. Frank rectal bleeding is usually not seen with diverticulitis.

B. Physical exam. Left-lower quadrant tenderness is characteristic. Abdominal examination is often deceptively unremarkable in the elderly and in persons taking corticosteroids.

Differential Diagnosis of Diverticulitis


Middle Aged and Young

Ischemic colitis



Colonic Obstruction Penetrating ulcer Nephrolithiasis/urosepsis

Appendicitis Salpingitis

Inflammatory bowel disease Penetrating ulcer Urosepsis

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Managing Diverticular Disease

Managing Diverticular Disease

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