Symptoms of Diverticulitis
Left lower quadrant abdominal pain is the hallmark symptom of diverticulitis, typically accompanied by fever, change in bowel habits, and tenderness on examination. 1
Primary Clinical Presentation
- Abdominal pain in the left lower quadrant is the most common presenting symptom, occurring in the majority of patients with acute diverticulitis 1, 2
- Fever frequently accompanies the abdominal pain, though the classic triad of left lower quadrant pain, fever, and leukocytosis is present in only approximately 25% of patients 3
- Abdominal tenderness on examination, typically localized to the left lower quadrant, is the most common physical finding 1, 4
Associated Gastrointestinal Symptoms
- Change in bowel habits is a common accompanying symptom, which may manifest as either constipation or diarrhea 1, 4, 5
- Nausea and vomiting occur in many patients, with vomiting being a risk factor for disease progression requiring antibiotic treatment 3, 2, 5
- Anorexia is frequently reported during the acute phase of diverticulitis 3, 5
- Abdominal distention may be present on examination 4, 5
Laboratory and Inflammatory Markers
- Elevated white blood cell count (leukocytosis) is commonly found on laboratory testing, with levels >15 × 10⁹ cells per liter indicating higher risk for progression to complicated disease 3, 1, 4
- Elevated C-reactive protein (CRP) is frequently present, with levels >140 mg/L indicating increased risk for complications and need for antibiotic therapy 3, 1, 4
Less Common Symptoms
- Dysuria may occur in some patients, likely due to bladder irritation from adjacent colonic inflammation 5
- Abdominal rigidity suggests more severe disease with possible peritonitis 6
Post-Acute Chronic Symptoms
- Ongoing periodic abdominal pain is reported by approximately 45% of patients at 1-year follow-up after an acute episode, usually attributable to visceral hypersensitivity rather than ongoing inflammation 3, 1
Important Clinical Caveats
The absence of the classic triad does not exclude diverticulitis—misdiagnosis based on clinical assessment alone has been reported in 34% to 68% of cases, which is why imaging confirmation with CT scan is recommended for most patients 3. The presence of persistent symptoms beyond 5 days, high pain scores (≥8/10), or systemic symptoms should prompt consideration of complicated disease or alternative diagnoses 3, 1.