Patients with acute uncomplicated diverticulitis classically present with left-sided lower abdominal pain, fever, and leukocytosis. 28 The site of pain often depends on the segment of colon affected. Right-sided symptoms may occur in the presence of right-sided diverticulosis, as well as in redundant sigmoid colon lying on the right side of the abdomen. Patients with left-sided pain may also have right-sided symptoms. Other common manifestations are frequently related to GI disturbances, with alteration in bowel habits, constipation, either alone or alternating with bouts of diarrhea, anorexia, and nausea and vomiting. Urinary symptoms such as dysuria, frequency, and urgency may develop in a minority of patients, probably because of the proximity of the bladder to the inflamed sigmoid colon. In acute presentations, fever is almost always present, but high fever must suggest the possibility of advanced disease and sepsis from generalized peritonitis caused by perforation and spreading of inflammation in the peritoneum.
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