Acute diverticulitis--clinical presentation and differential diagnostics.
OBJECTIVE
To describe the clinical presentation of acute diverticulitis in an emergency department and to characterize the natural history of diverticulitis in the short perspective. Comparisons are made with an important differential diagnosis, nonspecific abdominal pain (NSAP).


METHODS
Patients admitted to our hospital with abdominal pain of up to 7 days' duration were registered prospectively using a detailed schedule for history, symptoms and signs, from 1 February 1997 to 1 June 2000. Of 3349 patients initially included, 3073 (92%) were eligible for follow up after 1-3 years.


RESULTS
Acute diverticulitis was the final diagnosis in 145 patients and NSAP in 1142 patients. The incidence of hospitalized patients with diverticulitis was 47 per year and 100 000 population, with a mean hospital stay of 3.3 days. Patients with diverticulitis, more frequently than NSAP, had a longer history and laboratory signs of inflammatory activity. Isolated left abdominal tenderness was more common in diverticulitis, whereas isolated right abdominal tenderness was more common in NSAP. Duration of symptoms on arrival was independent of age and was not correlated to C-reactive protein, leucocytes or body temperature. Sensitivity of diverticulitis as primary diagnosis was 64% and specificity 97%. Corresponding figures for NSAP were 43% and 90% respectively. Age and gender did not influence diagnostic accuracy or risk of surgery.


CONCLUSIONS
Diverticulitis differs significantly from NSAP in clinical presentation and laboratory parameters. Sensitivity of primary diagnosis for diverticulitis and NSAP was low.
Laurell
H
H
Department of Surgery at Mora Hospital, Mora, Sweden. helena.laurell@kirurgi.uu.se
Hansson
L-E
LE
Gunnarsson
U
U
D015746:Abdominal Pain / Q000175:diagnosis; D000208:Acute Disease; D000328:Adult; D000368:Aged; D001831:Body Temperature; D002097:C-Reactive Protein / Q000032:analysis; D003937:Diagnosis, Differential; D004239:Diverticulitis, Colonic / Q000175:diagnosis*; D005260:Female; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity
D002097:C-Reactive Protein