Diverticulosis differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Seyedmahdi Pahlavani, M.D. [2]

Overview

Diverticulosis must be differentiated from other diseases that cause abdominal discomfort, bloating, and occasional bleeding, such as other diverticular diseases (diverticulitis and diverticular bleed), as well as other GI diseases, such as acute pancreatitis, colon cancer, colitis, inflammatory bowel disease, bowel obstruction, volvulus, and appendicitis.

Differential Diagnosis

Differential diagnosis of diverticulosis includes the following:^[1]

Diverticulitis
Diverticular bleed
Perforation / rupture
Acute pancreatitis
Intra-abdominal abscess
Colon cancer and polyps
Inflammatory bowel disease
Irritable bowel syndrome
Pseudomembranous colitis and other infectious colitis
Ischemic colitis
Appendicitis
Bowel obstruction
Volvulus
Anal fissure
Hemorrhoids
Angiodysplasia
Post-polypectomy
GI bleed
Ulcers (gastric or colonic)

	Symptoms					Lab Findings	Imaging
Diseases	Clinical manifestations					Para-clinical findings				Gold standard
	Symptoms					Para-clinical findings
	Bowel frequency	Blood in stool	Abdominal pain	Tenesmus	Other symptoms	Anemia	Colonoscopy	CT scan	Other diagnostic study
Diverticular diseases^[2]^[3]^[4]	↑ or ↓	+/-	+ RLQ	-	Fever Chills N/V	-	Not recommended	Outpouchings of the colonic wall (diverticula) Inflamed diverticula Abscess formation Intraperitoneal free air (microperforation)	Barium enema Circumferential narrowing Spiculated contour Tapered margins	CT scan
Hemorrhoids^[5]	↓	+	+	-	Perianal Itching Pain with defecation Painful-hard lump in anus	+	Anoscopy Protruding mass from the anus	N/A	DRE Palpable mass, tender if thrombosed	Clinical
Anal fissure^[6]	-	+	+	-	Painful defecation Itching Irritation	+/-	Anoscopy Anal wall laceration	N/A	N/A	Clinical
Infectious colitis^[7]	↑	+	+	-	Fever, chills N/V Bloating	-	Patchy or diffuse erythematous mucosa Edema, hemorrhage, with or without ulcers of mucosa	N/A	Stool analysis Leukocytosis Stool cultures	Stool culture
Irritable bowel syndrome^[8]	↑ ↓	+	+	+	Weight loss Straining Urgency Mucus passage Bloating	-	Not recommended	N/A	Diagnosis of exclusion Fulfilment of Rome criteria	Clinical diagnosis (Rome criteria)
Strangulated hernia	↓	-	+ RLQ	-	N/V Heaviness/dull discomfort in the groin, with straining, lifting, coughing, or exercising Weakness, heaviness, burning, or aching in the groin Swelling Fever	-	N/A	Defect in the abdominal wall muscles Bowel loops within the lesion Lateral crescent sign The hernia neck superolateral to the course of the inferior epigastric vessels	Ultrasound: Hypoechoic mass suggesting dilated and edematous intestinal segment	Ultrasound
Bowel endometriosis^[9]	↑ or ↓	+	+ Pelvic	+	Dyschezia	+	N/A	N/A	Transvaginal ultrasound Heterogeneous, hypoechoic, spiculated mass T1-weighted or fat-suppression T1-weighted MRIs Contrast enhanced mass Hyperintense hemorrhagic Hyperintense cavities	Transvaginal ultrasound
Appendicitis^[10]	↑	-	+ RLQ	-	Pain starting periumbilical before localizing to the RLQ N/V Fever Chills Loss of appetite	-	N/A	Appendiceal wall thickening (≥ 3mm) Periappendiceal fat stranding Thick lateral conal fascia and mesoappendix Extraluminal fluid Phlegmon Abscess	Ultrasound Aperistaltic, noncompressible, dilated appendix (>6 mm) Appendicolith Echogenic prominent pericaecal fat Periappendiceal fluid collection	CT scan

References

↑ Strate LL (2005). "Lower GI bleeding: epidemiology and diagnosis". Gastroenterol. Clin. North Am. 34 (4): 643–64. doi:10.1016/j.gtc.2005.08.007. PMID 16303575.
↑ Shen SH, Chen JD, Tiu CM, Chou YH, Chiang JH, Chang CY, Lee CH (September 2005). "Differentiating colonic diverticulitis from colon cancer: the value of computed tomography in the emergency setting". J Chin Med Assoc. 68 (9): 411–8. doi:10.1016/S1726-4901(09)70156-X. PMID 16187597.
↑ Shen, Shu-Huei; Chen, Jen-Dar; Tiu, Chui-Mei; Chou, Yi-Hong; Chiang, Jen-Huei; Chang, Cheng-Yen; Lee, Chen-Hsen (2005). "Differentiating Colonic Diverticulitis from Colon Cancer: The Value of Computed Tomography in the Emergency Setting". Journal of the Chinese Medical Association. 68 (9): 411–418. doi:10.1016/S1726-4901(09)70156-X. ISSN 1726-4901.
↑ Sheiman, Laura; Levine, Marc S.; Levin, Alicia A.; Hogan, Jonathan; Rubesin, Stephen E.; Furth, Emma E.; Laufer, Igor (2008). "Chronic Diverticulitis: Clinical, Radiographic, and Pathologic Findings". American Journal of Roentgenology. 191 (2): 522–528. doi:10.2214/AJR.07.3597. ISSN 0361-803X.
↑ Jacobs, Danny; Solomon, Caren G. (2014). "Hemorrhoids". New England Journal of Medicine. 371 (10): 944–951. doi:10.1056/NEJMcp1204188. ISSN 0028-4793.
↑ Schlichtemeier S, Engel A (2016). "Anal fissure". Aust Prescr. 39 (1): 14–7. doi:10.18773/austprescr.2016.007. PMC 4816871. PMID 27041801.
↑ DuPont HL (January 2012). "Approach to the patient with infectious colitis". Curr. Opin. Gastroenterol. 28 (1): 39–46. doi:10.1097/MOG.0b013e32834d3208. PMID 22080825.
↑ Iwańczak B, Iwańczak F (August 2017). "[Functional gastrointestinal disorders in children and adolescents. The Rome IV criteria]". Pol. Merkur. Lekarski (in Polish). 43 (254): 75–82. PMID 28875974.
↑ Wolthuis AM, Meuleman C, Tomassetti C, D'Hooghe T, de Buck van Overstraeten A, D'Hoore A (November 2014). "Bowel endometriosis: colorectal surgeon's perspective in a multidisciplinary surgical team". World J. Gastroenterol. 20 (42): 15616–23. doi:10.3748/wjg.v20.i42.15616. PMC 4229526. PMID 25400445.
↑ Choi D, Park H, Lee YR, Kook SH, Kim SK, Kwag HJ, Chung EC (2003). "The most useful findings for diagnosing acute appendicitis on contrast-enhanced helical CT". Acta Radiol. 44 (6): 574–82. PMID 14616200.

Template:WH Template:WS

[pmid16303575-1] Strate LL (2005). "Lower GI bleeding: epidemiology and diagnosis". Gastroenterol. Clin. North Am. 34 (4): 643–64. doi:10.1016/j.gtc.2005.08.007. PMID 16303575.

[pmid16187597-2] Shen SH, Chen JD, Tiu CM, Chou YH, Chiang JH, Chang CY, Lee CH (September 2005). "Differentiating colonic diverticulitis from colon cancer: the value of computed tomography in the emergency setting". J Chin Med Assoc. 68 (9): 411–8. doi:10.1016/S1726-4901(09)70156-X. PMID 16187597.

[ShenChen2005-3] Shen, Shu-Huei; Chen, Jen-Dar; Tiu, Chui-Mei; Chou, Yi-Hong; Chiang, Jen-Huei; Chang, Cheng-Yen; Lee, Chen-Hsen (2005). "Differentiating Colonic Diverticulitis from Colon Cancer: The Value of Computed Tomography in the Emergency Setting". Journal of the Chinese Medical Association. 68 (9): 411–418. doi:10.1016/S1726-4901(09)70156-X. ISSN 1726-4901.

[SheimanLevine20082-4] Sheiman, Laura; Levine, Marc S.; Levin, Alicia A.; Hogan, Jonathan; Rubesin, Stephen E.; Furth, Emma E.; Laufer, Igor (2008). "Chronic Diverticulitis: Clinical, Radiographic, and Pathologic Findings". American Journal of Roentgenology. 191 (2): 522–528. doi:10.2214/AJR.07.3597. ISSN 0361-803X.

[JacobsSolomon2014-5] Jacobs, Danny; Solomon, Caren G. (2014). "Hemorrhoids". New England Journal of Medicine. 371 (10): 944–951. doi:10.1056/NEJMcp1204188. ISSN 0028-4793.

[pmid27041801-6] Schlichtemeier S, Engel A (2016). "Anal fissure". Aust Prescr. 39 (1): 14–7. doi:10.18773/austprescr.2016.007. PMC 4816871. PMID 27041801.

[pmid22080825-7] DuPont HL (January 2012). "Approach to the patient with infectious colitis". Curr. Opin. Gastroenterol. 28 (1): 39–46. doi:10.1097/MOG.0b013e32834d3208. PMID 22080825.

[pmid28875974-8] Iwańczak B, Iwańczak F (August 2017). "[Functional gastrointestinal disorders in children and adolescents. The Rome IV criteria]". Pol. Merkur. Lekarski (in Polish). 43 (254): 75–82. PMID 28875974.

[pmid25400445-9] Wolthuis AM, Meuleman C, Tomassetti C, D'Hooghe T, de Buck van Overstraeten A, D'Hoore A (November 2014). "Bowel endometriosis: colorectal surgeon's perspective in a multidisciplinary surgical team". World J. Gastroenterol. 20 (42): 15616–23. doi:10.3748/wjg.v20.i42.15616. PMC 4229526. PMID 25400445.

[pmid14616200-10] Choi D, Park H, Lee YR, Kook SH, Kim SK, Kwag HJ, Chung EC (2003). "The most useful findings for diagnosing acute appendicitis on contrast-enhanced helical CT". Acta Radiol. 44 (6): 574–82. PMID 14616200.

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Diverticulosis differential diagnosis

Overview

Differential Diagnosis

References

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