Pathophysiology of diverticulitis
(NEJM 2007;357:2057; Gastro 2015;149:1944)
- Retention of undigested food and bacteria in diverticulum → fecalith formation → obstruction → compromise of diverticulum’s blood supply, infection, microperforation
- Uncomplicated (75%): microperforation → localized infection, LLQ pain, fever, ↑ WBC
- Complicated (25%): macroperf → abscess, peritonitis, fistula (65% w/ bladder), obstrxn Clinical manifestations
- LLQ abdominal pain, fever, nausea, vomiting, constipation or diarrhea
- PEx ranges from LLQ tenderness ± palpable mass to peritoneal signs & septic shock
- Ddx includes IBD, infectious colitis, PID, tubal pregnancy, cystitis, colorectal cancer