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:

• 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)

Diseases	Clinical manifestations					Para-clinical findings				Gold standard
	Symptoms
						Lab Findings	Imaging
	Bowel frequency	Blood in stool	Abdominal pain	Tenesmus	Other symptoms	Anemia	Colonoscopy	CT scan	Other diagnostic study
Diverticular diseases	↑ 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	↓	+	+	-	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	-	+	+	-	Painful defecation Itching Irritation	+/-	Anoscopy Anal wall laceration	N/A	N/A	Clinical
Infectious colitis	↑	+	+	-	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	↑ ↓	+	+	+	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	↑ 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