>>> DR. KENNETH FALCHUK: Abdominal pain is a broad subject, but if someone is concerned about a specific disease such as diverticulitis, the pain usually is acute. More often than not it is a pain centered to the lower abdomen, more commonly or not, the left side of the abdomen. We call it the left lower abdominal quadrant. That is an area where most of diverticula usually occur. It is an area where the bowel is somewhat narrow and a little curved and when diverticulitis occurs, develops, that means inflammation within the diverticula, and the pain will be or can be quite severe and can also be mild. Patients may develop a change in the bowel pattern, they may become constipated, and they cannot eliminate the stools as well they may even feel bloated. Sometimes the pain is quite intense when the patient is doubled over. Sometimes the patient can have a fever with chills, a sign of an infection. What diverticulitis really is, the definition, is perforation that means a little hole that could be small, does not have to be large, in one of the diverticula or in several diverticula.
So in the space, the area of the colon where these are located, things become narrow, swollen, we call it edema. Pus can collect and that is called abscess and therefore patients can be quite ill, they need to be seen promptly. Many cases of diverticulitis tend to be mild, mild in the sense that patient can be seen by a physician as an outpatient, evaluated, diagnosis established and be treated with antibiotics. The specific way to make the diagnosis is not only the clinical presentation. The clinical finding is the need to do an x-ray, a CT scan with contrast of the abdomen focussing in the area where the pain is present.
Now that does not mean that you cannot have diverticulitis in other segments of the colon. It could be at the right side, it could be at the mid-portion of the transverse colon. As I said previously, the left side of the colon, the sigmoid colon, is the predominant site where diverticulitis develops. Abdominal pain is a broad symptom. It is caused by many conditions so it is important for the physician to know how to proceed and differentiate, what we call established differential diagnosis or in another conditions, it could be a catastrophe of something is leaking into the abdomen. There could be another abscess. There could be a perforated appendix and so and so, that is why prompt evaluation, proper x-ray studies and laboratory studies as well and then proceed with a treatment and followup..