Diverticulitis Symptoms in Adults Over 40
The most common presenting symptom of diverticulitis is acute or subacute left lower quadrant abdominal pain, typically accompanied by fever, changes in bowel habits, nausea, and leukocytosis. 1, 2
Primary Clinical Presentation
Cardinal symptoms include:
- Left lower quadrant pain - present in approximately 67% of younger patients and only 50% of elderly patients over 65 years 3, 4
- Fever - occurs in 71% of younger patients but only 17% of elderly patients 3, 4
- Leukocytosis - present in 90% of younger patients but absent in 43% of elderly patients 3, 4
- Elevated C-reactive protein (CRP) - commonly elevated alongside white blood cell count 3, 5
Additional Common Symptoms
Gastrointestinal manifestations:
- Nausea - present in 86% of patients 4
- Changes in bowel habits - including constipation or diarrhea 1, 5
- Anorexia 5
- Abdominal distention and tenderness 5
- Dysuria - may occur due to bladder irritation 5
Critical Age-Related Differences
Elderly patients (>65 years) present with more nuanced symptoms:
- Only 50% have abdominal pain in the lower quadrants (compared to 67% in younger patients) 3
- Only 17% have fever (compared to 71% in younger patients) 3
- 43% do not have leukocytosis 3
- Higher proportion present with diverticular bleeding rather than inflammatory symptoms 3
This atypical presentation in elderly patients often leads to delayed diagnosis and higher mortality rates. 3
Physical Examination Findings
Key examination findings include:
- Tachycardia - mean pulse rate of 103 bpm in acute presentations 4
- Fever - mean temperature of 100.7°F 4
- Left lower quadrant tenderness - the hallmark physical finding 3
- Abdominal distention 5
Diagnostic Accuracy of Clinical Presentation Alone
Clinical diagnosis lacks accuracy - the positive predictive value of clinical diagnosis alone is only 40-65%, with a more precise value of 0.65 in prospective studies. 3, 2 This is why imaging, particularly CT scanning, is essential for confirmation rather than relying on symptoms alone. 3, 2
Right-Sided Presentations
While 90% of Western patients have left-sided disease, right lower quadrant pain can occur:
- 24% of younger patients may present with right lower quadrant pain, often confused with appendicitis 4
- Asian and African descent populations have right-sided disease in 70-74% of cases 3
When Imaging Is Essential
Despite classic symptoms, CT imaging is recommended because:
- Clinical suspicion alone is correct in only 40-65% of cases 2
- Imaging improved diagnostic accuracy in 37% of patients in prospective studies 3
- CT has 95-99% sensitivity and 99-100% specificity compared to clinical diagnosis 2, 6
The classic clinical triad of left lower quadrant pain, fever, and leukocytosis should raise strong suspicion for diverticulitis, but imaging confirmation is essential for accurate diagnosis and to exclude complications. 3