Twelve Patients with Irritable Bowel Syndrome Whose Diagnosis of Diverticulitis Was Subsequently Revised or Excluded (2003 to 2017)
| Case # Age Sex | Presenting Features and Therapy of Clinically Diagnosed Diverticulitis | Prior Colon Imaging | Later Events, Revised Diagnosis, Therapy and Outcome |
|---|---|---|---|
| 1 6 F | Abdominal pain, diarrhea ×3 weeks, generalized abdominal tenderness. T 36.6°C, Long-term cephalexin usage for cystitis. Leukocytes 7900/mm3. Ciprofloxacin/metronidazole. | Barium enema 8 years before— diverticulosis | Hospitalized 2 days later, diarrhea and weakness. CT—no diverticulitis, C. difficile toxin–positive colitis, acute renal failure. Vancomycin—recovered. IBS symptoms during 4.3-year followup. |
| 2 90 F | Diarrhea, mild LLQ pain ×1 week. Took amoxicillin or cephalexin daily in cycles until 10 weeks before, then took vancomycin for unproven C. Difficile infection until 2 weeks before. T 36.8°C, LLQ tenderness. Leukocytes 11,600/mm3. Ciprofloxacin/metronidazole. | CT 0.4 years before, barium enema 8.3 years before—diverticulosis | Hospitalized 2 weeks later, severe bloody diarrhea. CT—sigmoid/descending colon wall thickening. Flexible sigmoidoscopy—severe pseudomembranous colitis.C. difficile toxin–positive.Vancomycin—recovered. Recurrent antibiotic-induced C. difficile diarrhea before death from heart failure 4.7 years later. |
| 3 77 F | Low abdominal pain ×2 days. T 36.9°C, LLQ tenderness. Leukocytes 9900/mm3. Amoxicillin/metronidazole. | Barium enema 6 years before— diverticulosis | Urinalysis—urinary tract infection. Therapy changed: Ciprofloxacin/metronidazole later the same day—recovered. Diverticulitis diagnosed clinically again 4.1 year later. IBS symptoms during 11-year followup. |
| 4 81 F | Low abdominal pain ×1 day. T 37.4°C, low abdominal tenderness. Leukocytes 12,700/mm3. Ciprofloxacin/metronidazole | CT 0.3 year before, colonoscopy 0.4 year before, barium enema 11 years before—diverticulosis | Urinalysis—urinary tract infection. Therapy changed: Amoxicillin clavulanate 6 days later—recovered. Diverticulitis diagnosed clinically again 0.2 year later. Died from cancer 2.6 years later. |
| 5 48 M | LLQ pain, urgency, bloody stool ×4 days. T 37.1°C, LLQ tenderness. Leukocytes 8400/mm3. Ciprofloxacin/metronidazole. | None | CT 2 days later—sigmoid wall thickening without diverticulosis. Symptoms persisted. Colonoscopy 3.5 months later—colitis. Drug therapy-refractory. Proctocolectomy (Crohn's disease) 2.6 years later. Stable during 10.8-year followup. |
| 6 36 F | Abdominal pain, diarrhea ×3 weeks. T 36.3°C, low abdominal tenderness. Leukocyte count not done. Ciprofloxacin/metronidazole. | None | Flexible sigmoidoscopy 6 days later—Crohn's disease. Erythema nodosum, arthritis 8 days later. Drug therapy—did well during 2.4-year followup. |
| 7 89 F | “LLQ pain” ×3 days, history of cholecystitis. T 37.5°C, “LLQ tenderness.” On penicillin for dental disease. Leukocytes 8600/mm3. Metronidazole added. | Colonoscopy 2.1 year before, CT 2.4 years before—diverticulosis. | Hospitalized 12 hours later, pain worse. Surgeon noted mid-abdominal pain, epigastric tenderness. Ultrasound—gallstones, gallbladder wall thickened—cholecystitis. Amoxicillin clavulanate—recovered. Occasional low abdominal pain until death from pneumonia 2.5 years later. |
| 8 77 M | Left abdominal pain ×1 day, history of metastatic ileal carcinoid and 2 episodes small bowel obstruction. T 36.8°C, left abdominal tenderness. Leukocytes 6700/mm3. Ciprofloxacin/metronidazole. | CT 1.2 years before, colonoscopy 7.2 years before—no diverticulosis. | Hospitalized 1 day later, pain worse, CT—small bowel obstruction. Resolved. Death from carcinoid 2.3 years later. |
| 9 81 F | Low abdominal pain, diarrhea ×10 days. T 36.7°C, low abdominal tenderness. Leukocyte count not done. Ciprofloxacin. | Barium enema 9.5 years before—no diverticulosis | Hospitalized 5 days later, pain worse. CT—sigmoid volvulus. Colonoscopic detorsion—recovered. No visits for abdominal pain until death from cancer 1.7 years later. |
| 10 50 F | LLQ pain ×1 day. T 36.4°C, LLQ tenderness. Leukocytes 9800/mm3. Ciprofloxacin/metronidazole. | Flexible sigmoidoscopy 1.4 years before, colonoscopy 0.8 years before—no diverticulosis. | To ED 2 days later, pain persistent. CT—4.6-cm left ovarian cyst. Oophorectomy (cystadenoma) 6 weeks later. No visits for abdominal pain during 4-year followup. |
| 11 67 M | Mid-abdominal pain, ×1 day.T 37.1°C, “LLQ tenderness.” Leukocytes 15,300/mm3. Ciprofloxacin/metronidazole | Colonoscopy 0.7 years before—diverticulosis | Hospitalized 13 days later, pain persisted, worsened. Severe RUQ tenderness. Leukocytes 18,300/mm3. CT—gallstones, gallbladder wall thickened with surrounding edema. Lipase, liver tests increased. Cholecystitis, pancreatitis. Cholecystectomy (chronic cholecystitis with focal gangrene)—recovered. Occasional IBS symptoms during 7.2-year followup. |
| 12 86 F | Presenting history, examination, temp data unavailable. Leukocyte count not done. Ciprofloxacin/metronidazole | None | To ED 3 days later due to vomiting, bloating after starting antibiotics. CT—diverticulosis without diverticulitis. Drug-induced symptoms. Antibiotics stopped. Recovered. Many visits for IBS symptoms, depression, anxiety and 3 more nondiagnostic CTs done for abdominal pain before general decline and death 7.2 years later. |
CT, computed tomography; ED, emergency department; F, female; M, male; IBS, irritable bowel syndrome; LLQ, left lower quadrant; RUQ, right upper quadrant; T, temperature.
Revised Diagnoses in Bold.