Table 3.

Twelve Patients with Irritable Bowel Syndrome Whose Diagnosis of Diverticulitis Was Subsequently Revised or Excluded (2003 to 2017)

Case # Age SexPresenting Features and Therapy of Clinically Diagnosed DiverticulitisPrior Colon ImagingLater Events, Revised Diagnosis, Therapy and Outcome
6 F
Abdominal pain, diarrhea ×3 weeks, generalized abdominal tenderness. T 36.6°C, Long-term cephalexin usage for cystitis.
Leukocytes 7900/mm3.
Barium enema 8 years before— diverticulosisHospitalized 2 days later, diarrhea and weakness.
CT—no diverticulitis,
C. difficile toxin–positive colitis, acute renal failure.
IBS symptoms during 4.3-year followup.
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.
CT 0.4 years before, barium enema 8.3 years before—diverticulosisHospitalized 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.
77 F
Low abdominal pain ×2 days.
T 36.9°C, LLQ tenderness.
Leukocytes 9900/mm3.
Barium enema 6 years before— diverticulosisUrinalysis—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.
81 F
Low abdominal pain ×1 day.
T 37.4°C, low abdominal tenderness.
Leukocytes 12,700/mm3.
CT 0.3 year before, colonoscopy 0.4 year before, barium enema 11 years before—diverticulosisUrinalysis—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.
48 M
LLQ pain, urgency, bloody stool ×4 days. T 37.1°C, LLQ tenderness.
Leukocytes 8400/mm3.
NoneCT 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.
36 F
Abdominal pain, diarrhea ×3 weeks. T 36.3°C, low abdominal tenderness.
Leukocyte count not done.
NoneFlexible sigmoidoscopy 6 days later—Crohn's disease. Erythema nodosum, arthritis 8 days later. Drug therapy—did well during 2.4-year followup.
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.
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.
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.
81 F
Low abdominal pain, diarrhea ×10 days. T 36.7°C, low abdominal tenderness.
Leukocyte count not done.
Barium enema 9.5 years before—no diverticulosisHospitalized 5 days later, pain worse. CT—sigmoid volvulus. Colonoscopic detorsion—recovered. No visits for abdominal pain until death from cancer 1.7 years later.
50 F
LLQ pain ×1 day. T 36.4°C, LLQ tenderness.
Leukocytes 9800/mm3.
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.
67 M
Mid-abdominal pain, ×1 day.T 37.1°C, “LLQ tenderness.” Leukocytes 15,300/mm3.
Colonoscopy 0.7 years before—diverticulosisHospitalized 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.
86 F
Presenting history, examination, temp data unavailable. Leukocyte count not done. Ciprofloxacin/metronidazoleNoneTo 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.