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Diagnosis of intestinal diverticulosis
Last reviewed: 03.07.2025
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Laboratory diagnostics of intestinal diverticulosis
In uncomplicated diverticulosis, laboratory testing is performed when establishing a diagnosis to exclude other diseases. Suspicion of complications dictates the need for a detailed laboratory examination.
Mandatory laboratory tests
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- Complete blood count: diverticulosis may cause leukocytosis with a left shift in the leukocyte formula and an increase in ESR. However, a normal leukocyte count in the blood does not exclude the presence of acute diverticulitis. In case of bleeding, there are signs of iron deficiency anemia (decreased hemoglobin content,red blood cell count, color index).
- General urine analysis - to exclude urinary tract lesions, such as urinary infection, pyelonephritis, urolithiasis (as part of differential diagnosis). In the case of intestinal-vesical fistula, leukocytes, erythrocytes, intestinal contents components, and bacteria specific to the intestine may be detected in the urine.
- Coprogram - in case of complications, it is possible to detect signs confirming the presence of inflammation: neutrophilic leukocytes, a large number of macrophages, desquamated epithelium.
The stool test for occult blood is positive in both microperforation and bleeding.
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Additional laboratory tests
In women of childbearing age, a pregnancy test should be performed (to exclude ectopic pregnancy). In case of recent antibacterial therapy, pseudomembranous colitis should be excluded by detection of Clostridium toxin in the stool.difficile.
In the presence of hypochromic anemia - determination of the concentration of serum iron, TIBC, and mean corpuscular hemoglobin.
Coagulogram, hematocrit if intestinal bleeding is suspected.
Carcinoembryonic antigen in case of suspected tumor.
In dynamics (in case of changes during the first study):
- clinical blood test;
- serum iron concentration, TIBC, mean corpuscular hemoglobin content;
- fecal occult blood test;
- general urine analysis.
Instrumental diagnostics of intestinal diverticulosis
Confirmation of the presence of diverticulum(s) by imaging studies is necessary.
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Mandatory examination methods
Colonoscopy is the method of choice for uncomplicated diverticulosis. Characteristic endoscopic signs of diverticulosis are the presence of single or multiple diverticulum openings in the intestinal wall. A blood vessel is often found near the diverticulum opening. Increased tone and rigidity of the intestinal wall are determined in the diverticulum area. When the diverticulum is close to the physiological sphincters, the latter are in spasm and open with difficulty. In addition to detecting the diverticulum itself, colonoscopy allows visualizing the source of intestinal bleeding.
If complications are suspected, colonoscopy carries the risk of perforation when air is injected into the colon, so preference is given to CT of the abdominal organs.
All patients with suspected complicated diverticulosis should undergo plain abdominal X-ray (in the standing and lying position) to exclude perforation of the diverticulum and intestinal obstruction. Pneumoperitoneum due to perforation is found in 3-12% of patients with acute diverticulitis.
Ultrasound of abdominal organs is used as an auxiliary method when the interpretation of findings using other methods is ambiguous. Ultrasound is especially indicated in cases of suspected acute diverticulitis (exacerbation of chronic), acute abdomen, in the presence of an infiltrate in the abdominal cavity. Signs of diverticulitis are detected - local thickening of the intestinal wall, edema, soreness of the affected section of the intestine during examination. According to indications, ultrasound of the bladder, kidneys, genitals is performed. Contrast X-ray examination.
Barium enema irrigoscopy is performed to detect colon diverticula (this method of examination does not exclude the risk of diagnostic errors). Colon diverticula can also be detected by oral contrast examination 24-72 hours after ingestion of barium suspension, but this method is less informative than irrigoscopy.
X-ray examination of the small intestine is performed if there is a suspicion of diverticula in it. To diagnose Meckel's diverticulum, barium is introduced through a probe behind the Treitz ligament.
CT of the abdominal organs is the method of choice when complications of diverticular disease are suspected, allowing not only to assess lumen changes (the possibilities of barium enema irrigoscopy), but also to characterize the prevalence of the inflammatory process (intramural, extramural lesions, involvement of adjacent organs); the method demonstrated better sensitivity and specificity for detecting acute diverticulitis compared to irrigoscopy.
If diverticulosis of the colon has been previously diagnosed and acute diverticulitis is suspected at the time of examination, irrigoscopy and colonoscopy are contraindicated due to the risk of perforation. The examination is performed against the background of the inflammatory process subsiding - usually 7-10 days after the start of treatment.
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Additional examination methods
- Cystoscopy and cystography - for the diagnosis of vesicointestinal fistulas.
- Intravenous urography allows detection of involvement of the ureters in the inflammatory process.
- Angiography is a diagnostic method used for bleeding from a diverticulum. It is possible to carry out therapeutic measures by embolization of the bleeding vessel.
- Fistulography - to detect fistulas.
If other methods of examination are uninformative, it is necessary to discuss the advisability of laparoscopy, which allows to exclude other diseases to a greater extent than to establish a diagnosis of complicated diverticular disease. It should be borne in mind that laparoscopy itself can be fraught with iatrogenic complications.
If a tumor is suspected during an endoscopic examination of the intestine, a targeted biopsy is performed followed by histological and cytological examination of the biopsy specimens.
Differential diagnosis of intestinal diverticulosis
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Irritable bowel syndrome
In case of irritable bowel syndrome, irrigoscopy and colonoscopy show no organic changes in the colon.
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Inflammatory bowel disease
Crohn's disease: characterized by abdominal pain, usually in the right lower quadrant of the abdomen, diarrhea, weight loss. Extraintestinal manifestations are possible: arthritis, skin lesions, uveitis.
Pseudomembranous colitis: abdominal pain, including colic-like pain, is typical, combined with diarrhea, nausea, vomiting and fever. Intestinal damage is caused by recent antibiotic therapy or hospital infection. Differential diaschosis requires stool testing for Clostridium toxindifficile.
Acute appendicitis: positive Kocher's sign, subfebrile condition, anorexia, possible single vomiting, symptoms of peritoneal irritation in the right abdominal region. In general, the clinical symptoms resemble those of diverticulitis. An appendicular abscess in its clinical picture resembles an abscess complicating the course of diverticulosis. However, diverticular disease is characterized by left-sided, not right-sided manifestations.
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Celiac disease
Diarrhea (in response to gluten products) and weight loss are typical. These symptoms may be combined with iron- or B12-deficiency anemia and osteoporosis.
Colorectal cancer
Progressive symptoms of partial intestinal obstruction are characteristic: periodically occurring abdominal pain, nausea, vomiting, constipation, diarrhea. Gastrointestinal bleeding and the formation of fistulas penetrating into adjacent organs are possible. Weight loss and anemia are typical. Endoscopic examinations are necessary for diagnosis.
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Ischemic colitis
Pain in the lower abdomen, often colicky, accompanied by diarrhea with blood in the stool, nausea, vomiting, and increased body temperature.
Additionally, in the differential diagnosis it is necessary to keep in mind gastric ulcer or duodenal ulcer complicated by bleeding or perforation, ovarian cysts and torsion, ovarian abscesses, ectopic pregnancy, urolithiasis, acute pyelonephritis or exacerbation of chronic pyelonephritis.