Typical Symptoms of Uncomplicated Left-Sided Diverticulitis
Uncomplicated left-sided diverticulitis classically presents with left lower quadrant pain or tenderness, often accompanied by fever and leukocytosis, though this complete triad occurs in only approximately 25% of cases. 1
Core Clinical Presentation
Primary Symptom
- Acute pain or tenderness in the left lower quadrant is the hallmark symptom, reflecting localized inflammation of sigmoid or descending colon diverticula 1
Associated Symptoms
- Fever – present in the classic triad but not universal 1
- Anorexia – loss of appetite commonly accompanies the acute inflammatory process 2
- Nausea – frequently reported alongside abdominal discomfort 2, 3
- Constipation – altered bowel habits are typical 2
- Diarrhea – some patients experience loose stools rather than constipation 2
- Dysuria – urinary symptoms can occur due to proximity of inflamed sigmoid colon to the bladder 2
- Abdominal distention – may develop as inflammation progresses 2, 4
Laboratory Findings
- Elevated white blood cell count (leukocytosis) – part of the classic triad but variable in presentation 1
- Elevated C-reactive protein (CRP) – increased inflammatory markers support the diagnosis 1
Critical Diagnostic Caveat
Clinical diagnosis based on symptoms alone is unreliable, with misdiagnosis rates of 34-68%. 1, 5 The classic triad of left lower quadrant pain, fever, and leukocytosis is present in only 25% of patients with diverticulitis, making imaging essential for confirmation. 1, 5
High-Accuracy Clinical Decision Rule
When all three of the following criteria are present, the diagnosis of acute diverticulitis has 97% accuracy 1:
- Direct tenderness only in the left lower quadrant
- CRP >50 mg/L
- Absence of vomiting
However, this combination occurs in only 24% of patients with suspected diverticulitis. 1
Imaging Confirmation
CT abdomen and pelvis with IV contrast is the gold standard diagnostic test, with 98-99% sensitivity and specificity, and should be obtained in most cases to confirm uncomplicated disease and exclude complications. 1, 5, 3 CT findings in uncomplicated diverticulitis include diverticula, thickening of the bowel wall, and increased density of the pericolic fat, without abscess or perforation. 1
Common Pitfall
Do not rely on clinical examination alone to make treatment decisions—the poor diagnostic accuracy means that imaging is essential to distinguish uncomplicated diverticulitis from complicated disease, colonic malignancy, and other causes of left lower quadrant pain. 1, 5