In this slideshow, skim through the different presentations of diverticulitis. Each slide links to the full case report for more details.
Small Bowel Diverticulitis
A previously healthy 34-year-old woman with no past surgical history presented to the emergency department reporting abdominal pain. The patient stated that she had been in her usual state of health but while resting overnight had developed discomfort localized to the periumbilical region, which she described as sharp and stabbing. She denied radiation of pain elsewhere. The pain was not associated with nor aggravated by meals; however, she did admit to exacerbation of pain with any body movement, relieved by lying completely still in her bed.
A 38-year-old woman, who was 28 weeks pregnant, presented with a 2-day history of worsening left lower quadrant abdominal pain. She had associated nausea, 1 episode of nonbilious, nonbloody emesis on day of admission along with chills, but no fevers. She reported that the abdominal pain was similar in character to her 2 prior episodes of diverticulitis.
The patient reported having normal stools without evidence of melena or hematochezia. She denied vaginal bleeding, leaking of amniotic fluid, or contractions; fetal movement was normal. She was afebrile and vital signs were stable.
Physical exam was remarkable for tenderness of the left lower quadrant to palpation without rebound or guarding. Fetal monitoring was reassuring. Significant laboratory findings included an elevated white blood cell count of 17.4 g/dL with an absolute neutrophil count of 14 g/dL. After an abdominal ultrasound was normal, an abdominal MRI without contrast was obtained.
Epiploic Appendagitis Mimicking Diverticulitis
A 25-year-old man presented to the emergency department after having been referred by his primary care provider (PCP). The patient presented with a 4-day history of sudden pain in the left lower quadrant, leading to the PCP’s initial diagnosis of diverticulitis. During the history, the patient described sharp, severe, nonradiating pain, which was aggravated by eating, movement, and deep breathing. The patient denied nausea, vomiting, change in bowel movements, fever, or fatigue, but he had noticed a loss of appetite. Previous medical and family history was noncontributory. Social history revealed that he was a current cigarette smoker.
Slideshow: Presentations of Diverticulitis