The diagnosis is usually suspected by the clinical history and the findings on physical examination. The presence of peritoneal signs or generalized peritonitis should suggest free perforation or rupture of a peridiverticular abscess. The presence of an abdominal mass associated with occult blood in the stool could indicate colon cancer. Colonic or small bowel obstruction, though uncommon, may necessitate surgical intervention.
Barium contrast studies can easily demonstrate diverticulae but are insensitive in detecting the presence of diverticulitis. In addition, barium introduced under high pressure carries the risk of precipitating a colonic perforation. Abdominal CT is the diagnostic procedure of choice. 23 It can demonstrate inflammation of percolic fat, presence of diverticulae, thickening of the bowel wall, or peridiverticular abscess. 24 Colon cancer is best ruled out by sigmoidoscopy or colonoscopy.
The acute abdominal series may be normal or may demonstrate associated ileus, partial small bowel obstruction, free air indicating bowel perforation, or extraluminal collections of air that might indicate a walled-off abscess. Abdominal ultrasonography is an inexpensive noninvasive method but is operator-dependent and lacks specificity.
Laboratory studies should include routine screening blood tests, urinalysis, and an acute abdominal series. Unfortunately, in many cases laboratory studies are not helpful in the diagnosis. Leukocytosis was seen in only 36 percent of patients with acute diverticulitis. 25 Controversy exists regarding the use of sigmoidoscopy or contrast radiographic studies in the acute inflammatory state. The general opinion in the literature is that these studies should be performed after conservative medical management has been instituted and the acute inflammatory process has subsided.
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