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]



Diseases Clinical manifestations Para-clinical findings Gold standard
Symptoms
Lab Findings Imaging Histopathology
Bowel frequency Blood in stool Abdominal pain Tenesmus Other symptoms Anemia Colonoscopy CT scan Other diagnostic study
Diverticular diseases[2][3][4] ↑ or ↓ +/- +

RLQ

- -
  • Not recommended
Barium enema
  • Circumferential narrowing
  • Spiculated contour
  • Tapered margins
  • N/A
CT scan
Hemorrhoids[5] + + -
  • Perianal Itching
  • Pain with defecation
  • Painful-hard lump in anus
+ Anoscopy
  • Protruding mass from the anus
  • N/A
DRE
  • N/A
Clinical
Anal fissure[6] - + + - +/- Anoscopy
  • Anal wall laceration
  • N/A
  • N/A
  • N/A
Clinical
Infectious colitis[7] + + - -
  • N/A
Stool analysis

Stool cultures

  • N/A
Stool culture
Irritable bowel syndrome[8] ↑ ↓ + + + -
  • Not recommended
  • N/A
Diagnosis of exclusion
  • N/A
Clinical diagnosis (Rome criteria)
Strangulated hernia - +

RLQ

- -
  • N/A
Ultrasound:
  • N/A
Ultrasound
Bowel endometriosis[9] ↑ or ↓ + +

Pelvic

+ +
  • N/A
  • N/A
Transvaginal ultrasound
  • Heterogeneous, hypoechoic, spiculated mass

T1-weighted or fat-suppression T1-weighted MRIs

  • N/A
Transvaginal ultrasound
Appendicitis[10] - +

RLQ

- -
  • N/A

Ultrasound

  • Aperistaltic, noncompressible, dilated appendix (>6 mm)
  • Appendicolith
  • Echogenic prominent pericaecal fat
  • Periappendiceal fluid collection
N/A CT scan
Colorectal carcinoma (Adenocarcinoma)[11] ↑ or ↓ + +/- + + PET scans

Barium enema

Biopsy, genetic testing, and histopathological analysis
Peutz-Jeghers syndrome
[12][13][14][15][16]
↑ or ↓ + + - + Barium enema

MRI

Genetic testing for STK11 and colonoscopy
Carcinoids
[17][18][19][20][21]
+/- + - +
  • Well-defined single/multiple lesions
  • Round/ovoid in shape
  • Variable in size between 2-5 cm
PET scan (11C-5-hydroxytryptophan, 11C-5-HTP)

MRI

Ki-67 index

  • Solid/spongy nests of cells accentuated by neatly outlined luminal spaces
Biopsy and histopathological analysis
Juvenile Polyposis Coli[22][23][24][25][26] + + - + Barium study

Stool DNA test

Diagnose if any of the following positive:

Diagnostic criteria fulfilment
Gastrointestinal Stromal Tumors (GIST)[27][28][29][30][31] - +/- - - +/- Benign

Malignant GIST with metastasis:

Endoscopic ultrasonography

Benign:

Malignant GIST:

Endoscopic ultrasound

biopsy and histopathological analysis

Hamartoma[34] + + +
  • N/A
-
  • Large polypoid mass
Biopsy Biopsy
Colorectal Lymphoma[35][36] - +/- + - +
  • Polypoid or ulcerated mass, intramural lesion, aphthous ulcer, stricture, extraluminal mass, or diffuse, multiple polypoid lesions
Double-contrast enema

Biopsy

Biopsy
Kaposi's sarcoma[37] + + - +
  • N/A
Serology

Biopsy

Biopsy
Arteriovenous malformation[38] - + - -
  • N/A
+
  • Bright red, flat lesions
  • Rarely, polypoid
  • N/A
  • N/A
Accidental finding
Ulcerative colitis[39]V + +

LLQ

+ +
  • N/A
  • N/A
Endoscopic biopsy
Crohn's disease[39] + +

RLQ

+ +
  • N/A
  • N/A
Endoscopic biopsy


References

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