Most Common Symptom of Diverticular Disease
The most common symptom of diverticular disease is dull aching pain in the left lower quadrant (Answer D), which is the primary presenting feature in both acute diverticulitis and symptomatic uncomplicated diverticular disease. 1, 2
Clinical Presentation Pattern
Abdominal pain, typically acute or subacute in onset and localized to the left lower quadrant, is the most common presenting symptom of diverticular disease. 1, 2 This pain presentation is so characteristic that:
- Left lower quadrant pain is considered the best symptom to differentiate symptomatic uncomplicated diverticular disease (SUDD) from other conditions like irritable bowel syndrome 3
- The pain is often described as dull and aching, persisting for at least 24 consecutive hours in the left lower abdomen 3
- Severe and prolonged left lower-abdominal pain correlates with disease severity and inflammatory markers 3
Associated Symptoms (Secondary Features)
While pain is primary, other symptoms commonly accompany diverticular disease:
- Changes in bowel habits occur but are secondary to pain 1
- Fever may be present, particularly in acute diverticulitis 1
- Nausea without vomiting is characteristic (absence of vomiting is actually a diagnostic criterion) 1, 2
- Elevated inflammatory markers (CRP, WBC) support the diagnosis but are not symptoms 1
Why Other Options Are Less Common
Bleeding per rectum (Option A) is actually a separate complication called diverticular hemorrhage, not a typical presentation of diverticular disease 4. It occurs in a minority of patients and represents a distinct clinical entity.
Tenesmus (Option C) is not a characteristic feature of diverticular disease and is more commonly associated with rectal pathology or inflammatory bowel disease 1.
Clinical Diagnostic Approach
The diagnosis relies on the combination of:
When all three criteria are present, the positive predictive value for acute diverticulitis reaches 97% 1. However, clinical diagnosis alone has only 40-65% accuracy, which is why CT imaging with contrast is the gold standard for confirmation 1, 2.
Important Clinical Caveat
Most patients (61%) presenting with diverticular disease have had a previous documented attack 5, and symptoms are typically present for an average of 14 days before presentation 5. This chronic, recurrent pain pattern in the left lower quadrant distinguishes diverticular disease from acute surgical emergencies.