>>> 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
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
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.