Clinical features
Many people with diverticula of the large bowel have no signs or symptoms of bowel disease and are known to have the condition following special investigations of other abdominal symptoms.
The diverticula often cause no symptoms and are found when investigations of the bowel (e.g. colonoscopy, barium X rays) are carried out to elucidate other bowel symptoms.
Symptoms of diverticular disease arise in between 10 -25% of people who have diverticula. It is not known why some people develop symptoms and others remain symptom free. However symptoms occur more frequently in older age groups.
The main symptoms of diverticulitis, when they occur, are left sided colicky abdominal pain with abdominal distension and flatulence. The pain may be exacerbated by eating and relieved by defecation. It may also be associated with constipation and passage of hard faeces. Appetite and weight are normal. Abdominal examination is often normal but may reveal mild tenderness, the lower colon may be palpated as an indistinct mass.
If the diverticula become inflamed the person develops the clinical features of acute diverticulitis. Abdominal pain is the main presenting symptom and may be severe restricting usual activities. The abdomen becomes distended and the person is nauseated with vomiting, reduced appetite and fever. In most cases there is constipation, but some people have diarrhoea. On clinical examination a tender mass of affected bowel can be palpated in the lower abdomen with associated spasm in the abdominal muscles.
Complications
Untreated acute diverticulitis may lead to the development of an abdominal abscess, when the person becomes very unwell with high fever, blood poisoning, collapse and peritonitis.
Inflamed diverticula may perforate leading to peritonitis when the contents of the bowel discharge into the abdominal (peritoneal) cavity. Untreated this is a potentially fatal condition.
- Haemorrhage - sudden bleeding from a diverticulum causes frank bleeding from the back passage (rectum), and may lead to collapse.
- Intestinal obstruction - episodes of inflammation, either acute or previous, may cause narrowing (stricture) of a portion of the bowel causing obstruction.
- Fistula formation - an abnormal opening between the bowel and bladder, vagina or other parts of the intestine.
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Amended April 2008
