Acute diverticulitis in patients 40 years of age and younger

Acute colonic diverticulitis typically occurs in patients older than 60 yea rs of age but is uncommon in patients under the age of 40, which may lead t o a delay in diagnosis. Because abdominal pain is a very common presenting symptom in emergency department patients, we retrospectively analyzed the c ases of 21 patients 40 years of age and younger diagnosed with acute divert iculitis and characterized the presenting signs and symptoms, laboratory an d radiographic findings, treatment, and outcome. There were 17 men and 4 wo men with a mean age of 34.1 +/- 5.9 years. All patients had abdominal pain, with 14(67%) patients noting pain in the left lower quadrant (LLQ) and 5 ( 24%) patients noting right lower quadrant (RLQ) pain. Nausea was present in 18(86%) patients and fever in 15 (71%) patients. The mean pulse rate was 1 03 +/- 16 and the mean temperature was 100.7 +/- 1.4 F. Leukocytosis was pr esent in 19 (90%) patients. Plain abdominal radiographs were obtained in 19 (91%) patients and were normal in 15 (79%) of these cases. Computed tomogr aphic (CT) scans were obtained in 15 (71%) patients which revealed findings consistent with acute diverticulitis in 14 (93%) patients. The admitting d iagnosis was diverticulitis in 10 of the 12 patients with LLQ tenderness an d appendicitis in 4 of the 6 patients with RLQ tenderness, Overall, six pat ients were taken to surgery: three patients had cecal diverticulitis and th ree patients had perforated colonic diverticulitis. General treatment measu res included bowel rest in 18 (86%) patients, and intravenous fluids and an tibiotics in all patients. All patients survived. In conclusion, acute dive rticulitis is uncommon in patients under 40 years of age; however, this con dition may be confused with other conditions, usually acute appendicitis. A s a result, clinicians should consider acute diverticulitis in young patien ts with acute abdominal pain, especially if they are mate with nausea, feve r, tachycardia, and leukocytosis, and consider obtaining a CT scan to aid i n the diagnosis.(Am J Emerg Med 2000;18:140-142. Copyright (C) 2000 by W.B. Saunders Company).