Diverticulosis vs Diverticulitis
How to tell Diverticulosis and Diverticulitis apart when a board question makes them look alike.
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CT evidence of pericolic fat stranding with left lower quadrant pain separates diverticulitis from uncomplicated diverticulosis.
Side by side
Painless hematochezia in an older patient without fever or focal peritoneal pain suggests diverticulosis-related bleeding.
Left lower quadrant pain, fever, leukocytosis, and focal tenderness suggest acute diverticulitis.
Diverticulosis involves mucosal outpouchings at weak points of colonic wall where vasa recta penetrate.
Diverticulitis is inflammation or microperforation of diverticula with adjacent fat inflammation and possible abscess formation.
Diverticular bleeding is often diagnosed by colonoscopy or CT angiography when active bleeding is brisk, with stable inflammatory markers if no infection is present.
Diverticulitis commonly shows leukocytosis and CT abdomen/pelvis with colonic wall thickening plus pericolic fat stranding; complicated cases may show abscess, extraluminal air, or fistula.
The trap
Ordering colonoscopy during acute suspected diverticulitis can increase perforation risk and delay antibiotics. CT with IV contrast is the preferred initial diagnostic test in stable adults with compatible pain and systemic signs.
The repair move
Next best step: obtain CT-confirmed severity, then treat uncomplicated diverticulitis with bowel rest, oral hydration, and selective antibiotics when systemic signs are present, such as amoxicillin-clavulanate 875/125 mg twice daily for 4 to 7 days. If complicated disease has abscess larger than about 3 cm, arrange percutaneous drainage and broad IV therapy.
Try a free question
CoreA 70-year-old man has sudden painless maroon stool without abdominal pain. BP 126/74 mm Hg, HR 84/min, temp 36.8 C. Abdomen is soft and nontender, and WBC is normal. What is the most likely diagnosis?
Show answer and explanation
Answer: B. Diverticulosis with bleeding. Painless lower GI bleeding in an older patient with no inflammatory signs is most consistent with diverticulosis.
Why the other choices are tempting
- A. Diverticulitis usually causes focal pain, fever, and inflammatory findings.
- C. Ischemic colitis usually includes crampy abdominal pain and often bloody diarrhea.
- D. Appendicitis would localize pain to the right lower quadrant with tenderness.
- E. Perforated ulcer causes acute peritoneal signs, not isolated painless lower GI bleeding.
Flashcards
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What symptom pattern is typical of diverticulosis rather than diverticulitis?
Painless lower GI bleeding without fever or focal inflammatory pain is typical of diverticulosis.
Which CT finding supports diverticulitis?
Pericolic fat stranding with segmental wall thickening supports diverticulitis.
Quick answers
What is the fastest way to tell Diverticulosis from Diverticulitis?
CT evidence of pericolic fat stranding with left lower quadrant pain separates diverticulitis from uncomplicated diverticulosis.
What is the key clue for Diverticulosis?
Painless hematochezia in an older patient without fever or focal peritoneal pain suggests diverticulosis-related bleeding.
What is the key clue for Diverticulitis?
Left lower quadrant pain, fever, leukocytosis, and focal tenderness suggest acute diverticulitis.
What is the common trap with Diverticulosis vs Diverticulitis?
Ordering colonoscopy during acute suspected diverticulitis can increase perforation risk and delay antibiotics. CT with IV contrast is the preferred initial diagnostic test in stable adults with compatible pain and systemic signs.