Diverticular disease is a common finding in Western countries, with a prevalence of up to 70% among individuals at 60 years of age. The term diverticular disease includes the historically recognized conditions of diverticulosis, uncomplicated diverticulitis, complicated diverticulitis, and diverticular bleeding; it also includes the increasingly recognized condition of symptomatic uncomplicated diverticular disease. The diagnosis of symptomatic diverticular disease requires a history and physical examination, laboratory evaluation, and imaging. In uncomplicated diverticulitis, antibiotic therapy and hospital admission may not be required. In complicated diverticulitis and diverticular bleeding, consultation with a gastroenterologist or surgeon for endoscopy may be required to rule out malignancy and control diverticular bleeding. In addition, surgical consultation may be needed for those who have abscesses, fistula formation, or perforation and for those patients who are unstable.

Case 3. SA is a 55-year-old who presents with a 2-day history of progressively worsening left lower quadrant abdominal pain. He reports having a low-grade fever, anorexia, and blood and mucus in his stools for 1 day. He recalls a similar episode a few years ago; he saw a physician elsewhere and was given a diagnosis of diverticulitis without any diagnostic testing.

Epidemiology and Pathophysiology

Diverticular disease is a common finding in Western countries, with a prevalence of up to 70% among individuals at 60 years of age.¹ Diverticular disease encompasses a range of historically recognized diagnoses, including diverticulosis (development of diverticula, or sac-like pouches in the colon, without inflammation), acute uncomplicated and complicated diverticulitis, and diverticular bleeding.