Diverticulitis Diagnosis: Symptoms, Tests, and When to Seek Help

Clinical Diagnosis

Diverticulitis = inflammation of a diverticulum (colonic outpouching). Diagnosed by:

• Symptoms: LLQ abdominal pain (usually), fever, nausea/vomiting, constipation/diarrhea, urinary symptoms (if near bladder).
• Exam: LLQ tenderness, guarding, possible mass.
• Labs: Leukocytosis, ↑ CRP, mild anemia.
• Imaging (gold standard): CT abdomen/pelvis with IV/oral contrast – shows pericolic fat stranding, wall thickening, abscess, perforation.

Severity Classification (Hinchey)

• Stage 0: Uncomplicated (colonic wall thickening only)
• Stage Ia: Phlegmon (localized inflammation)
• Stage Ib: Abscess (<5 cm)
• Stage II: Pelvic/distant abscess (>5 cm)
• Stage III: Generalized purulent peritonitis
• Stage IV: Fecal peritonitis

When to Seek Care

• Persistent LLQ pain + fever
• Inability to tolerate oral fluids
• Signs of peritonitis (rigid abdomen, rebound)
• Immunocompromised, on immunosuppressants

Management Overview

• Uncomplicated: Oral antibiotics (ciprofloxacin + metronidazole or TMP-SMX) × 7–10 days; clear liquid diet → advance.
• Complicated (abscess): IV antibiotics ± percutaneous drainage.
• Peritonitis/free perforation: Emergency surgery (resection ± colostomy).