Clinical features

Clinical features

• In mild cases, symptoms such as distension, flatulence and a sensation of heaviness in the lower abdomen may be indistinguishable from those of irritable bowel syndrome. These symptoms are thought to result from a combination of increased luminal pressure a ff ecting wall tension and increased visceral hypersensitivity . Surgical treatment is rarely , if ever, appropriate for diverticular disease in the absence of complications. - Diverticulitis typically presents as persistent lower abdom - inal pain. There may be accompanying diarrhoea or consti - pation. The lower abdomen is tender, especially over the left iliac fossa, but occasionally also on the right side if the sigmoid loop lies across the midline. The sigmoid colon may be ten - der and thickened on palpation and rectal examination may reveal a tender mass if an abscess has formed. Distinguish - ing between diverticulitis and abscess formation is di ffi cult on clinical grounds alone and radiological imaging is essential. Generalised peritonitis as a result of free perforation pr esents - in the typical manner with systemic upset and generalised ten - - derness and guarding. Clinical features

Given the frailty of typical patients with sigmoid volvulus a history is not always forthcoming. Massive distension is key but pain is unusual and if present is a warning sign of isch aemia.

Figure 77.16 A sigmoid volvulus.