Diverticulitis occurs when small, bulging pouches, known as diverticula, form in the lining of the large intestine and become inflamed or infected. Diverticula are common, especially in individuals over 40, but usually cause no problems unless inflamed or infected. Its symptoms often overlap with other abdominal conditions, making accurate diagnosis a complex challenge.
Conditions That Mimic Diverticulitis
Irritable Bowel Syndrome (IBS) often causes abdominal pain, bloating, constipation, and diarrhea, overlapping symptoms with diverticulitis. However, IBS pain typically improves after a bowel movement and usually does not involve fever or chills, which are more indicative of diverticulitis.
Appendicitis, an inflamed appendix, causes pain often starting near the belly button and moving to the lower right abdomen. This can be confused with right-sided diverticulitis, which is less common but presents similarly. Inflammatory Bowel Disease (IBD), encompassing Crohn’s disease and ulcerative colitis, also shares symptoms like abdominal pain, cramping, and changes in bowel habits, sometimes including bloody stools. While IBD is a chronic inflammatory condition, diverticulitis involves infection or inflammation of the pouches themselves.
Gynecological issues, such as ovarian cysts or ectopic pregnancies, can cause severe lower abdominal or pelvic pain that might be mistaken for diverticulitis, particularly in women. Kidney stones cause intense pain in the lower back or side, nausea, vomiting, and frequent urination. This pain can radiate to the abdomen, mimicking gastrointestinal issues. Colon cancer also presents with abdominal pain, changes in bowel habits, and rectal bleeding, requiring careful differentiation.
Diagnostic Process for Diverticulitis
The diagnostic process for diverticulitis begins with a thorough medical history and physical examination. Healthcare providers inquire about the nature, location, and duration of abdominal pain, as well as any changes in bowel habits, fever, or other associated symptoms. A physical exam often includes checking for abdominal tenderness, a common finding, particularly in the lower left quadrant where diverticula most frequently occur. For women, a pelvic exam may also be conducted to rule out gynecological causes of abdominal pain.
Laboratory tests provide important clues regarding infection and inflammation. Blood tests, such as a complete blood count (CBC), can reveal an elevated white blood cell count, indicating an infection. C-reactive protein (CRP) levels are also measured, as elevated CRP suggests inflammation somewhere in the body. While these blood markers are not specific to diverticulitis, they help guide further investigation.
Imaging studies often confirm diverticulitis and rule out other conditions. A computed tomography (CT) scan of the abdomen and pelvis is the preferred imaging tool. CT scans provide detailed cross-sectional images that show inflamed or infected diverticula, assess severity, and identify complications such as abscesses or perforations. A colonoscopy is not typically performed during an acute attack due to perforation risk, but may be recommended later to confirm diagnosis or rule out other conditions like colon cancer.
Factors Contributing to Misdiagnosis
Several factors contribute to diverticulitis misdiagnosis. Symptoms like abdominal pain, changes in bowel habits, and fever are non-specific, common to many conditions. This overlap makes pinpointing the cause difficult based on clinical presentation alone.
Patient presentation variations also complicate diagnosis. While pain is often in the lower left abdomen, some individuals, like those of Asian descent, may have lower right abdominal pain, which can be confused with appendicitis. Elderly patients or those on certain medications, like corticosteroids, might show less pronounced symptoms, making clinical assessment less reliable.
Limitations or misinterpretation of diagnostic tests also contribute to errors. While CT scans are accurate, their interpretation requires expertise. Less precise imaging or no imaging can lead to diagnostic uncertainty. Diverticulitis can sometimes be diagnosed clinically without a CT scan, especially with mild symptoms. This increases misattribution risk, particularly in patients with pre-existing conditions like IBS.
Importance of Accurate Diagnosis
Accurate diagnosis of diverticulitis is important for effective management and patient well-being. Misdiagnosis can lead to delayed or inappropriate treatment. If not correctly identified, patients might receive unnecessary medications or procedures that do not address their true ailment.
Delayed treatment can result in serious complications. Complications include abscesses, bowel obstruction, or fistulas—abnormal connections. Severe cases can lead to perforation and peritonitis, a life-threatening abdominal infection requiring immediate intervention. An accurate diagnosis ensures patients receive correct antibiotics, dietary modifications, or surgical interventions, leading to improved outcomes and reduced complication risk.