Diverticulosis and Diverticular Disease
Diverticulosis is usually found incidentally during an unrelated diagnostic or screening procedure (Sopena 2011). In fact, asymptomatic diverticulosis is the most common finding on routine cancer-screening colonoscopy (Shahedi 2013).
Diverticular disease, including acute diverticulitis, can often be diagnosed on the basis of the patient’s signs and symptoms, including physical exam findings, medical history, and laboratory testing. In approximately one-third of cases, diagnostic imaging is necessary to make a diagnosis (Andeweg 2014; Bugiantella 2015).
Several abdominal and pelvic ailments must be ruled out to diagnose diverticular disease. These include appendicitis, bowel obstruction, colon cancer, ectopic pregnancy, gastroenteritis, inflammatory bowel disease, irritable bowel syndrome, kidney stones, diseases of the ovaries, pancreatitis, and urinary tract infection (Wilkins 2013). Computed tomography (CT) scan or abdominal ultrasound are the preferred diagnostic imaging modalities, when necessary, to establish a diagnosis of diverticular disease (Aydin 2012; Andeweg 2014).
Due to the risk of pain or complications, colonoscopy cannot be performed during an episode of diverticular disease or acute diverticulitis. However, it may be recommended four to six weeks after an acute episode has resolved, particularly in cases with complications or after a first episode of acute diverticulitis to rule out an underlying cancer (Bugiantella 2015; Wilkins 2013). Nevertheless, there is increasing evidence that CT imaging used in the initial assessment is adequate to identify cancer, leading some researchers to recommend against additional colonoscopies beyond the regular colon cancer screening schedule (Medina-Fernandez 2015).
While uncomplicated diverticular disease is not associated with changes in blood test parameters, acute diverticulitis may cause blood test abnormalities including:
- High white blood cell count (leukocytosis). A high number of white blood cells is seen in about 55% of cases of acute diverticulitis (Wilkins 2013) and indicates active infection or inflammation (Asadollahi 2011).
- Elevated C-reactive protein. C-reactive protein is a marker of inflammation. High levels (>50 mg/L) are frequently seen in people with acute diverticulitis, and very high levels (>200 mg/L) may be a sign of perforation (Wilkins 2013).
- Anemia. Anemia may develop due to bleeding of diverticula, especially in elderly patients (Lizardi-Cervera 2008).