Diagnostics/Treatment

• Usually asymptomatic

• May manifest with abdominal discomfort or pain, especially if associated with chronic constipation

• Diverticular bleeding

• Typically an incidental diagnosis

• No workup required

• Colonoscopy: diagnostic modality of choice for suspected symptomatic diverticulosis

  • Indications

    • Lower GI bleed

    • Recurrent abdominal pain and/or diarrhea

    • Concern for underlying malignancy

  • Findings: well-defined outpouching from the colonic wall

  • Avoid if acute diverticulitis is suspected.

  • Biopsy and histological analysis can be performed, if necessary

• Double-contrast barium enema: highly sensitive test to detect diverticulosis but not commonly performed

  • Consider in the workup of the following:

    • Recurrent LLQ pain without signs of acute inflammation

    • Altered bowel habits

    • Lower GI bleed in a hemodynamically stable patient if colonoscopy cannot be performed

  • Contraindications: suspected diverticulitis or perforated diverticulum

  • Findings: outpouching of the colonic wall of variable size

• Abdominal ultrasound

  • Indications: may be performed as part of the workup for nonspecific LLQ pain

  • Findings: outpouching from the colonic wall

• Asymptomatic diverticulosis

  • No treatment can reverse the growth of existing diverticula.

  • The goal is the prevention of progression

• Symptomatic uncomplicated diverticular disease: unclear

Consider the following measures to prevent disease progression and development of complications. See “Management of diverticulitis” for secondary prevention of recurrent diverticulitis. [14][[15]

• Dietary modification, e.g., high-fiber diet, DASH diet, or vegetarian diet [16]

• Weight reduction

• Vigorous physical activity

• Smoking cessation

• Treatment of alcoholism