Back Pain Causes and Diagnostic Approach

Intestinal Diverticuli and Back Pain

Intestinal diverticuli alone typically do not cause back pain unless complications develop such as diverticulitis with inflammation extending to surrounding tissues, as noted by the American College of Radiology and Gastroenterology 1, 2
When diverticulitis occurs, pain is usually localized to the left lower quadrant, but can radiate to the back in cases of severe inflammation or abscess formation, according to Gastroenterology 3
Complications of diverticulitis that may cause back pain include abscess formation, especially if located in the retroperitoneum, as reported by the American College of Radiology and Gastroenterology 1, 4
Fistula formation between the colon and adjacent structures can also cause back pain, as noted by Gastroenterology 3
Perforation with retroperitoneal involvement is another complication that may cause back pain, as reported by the American College of Radiology 5

The American College of Radiology recommends a CT scan of the abdomen and pelvis with IV and oral contrast as the preferred initial imaging modality, with high accuracy for diagnosing diverticulitis (sensitivity/specificity 95%), as noted by Gastroenterology 2
CT scan can evaluate for potential complications of diverticulitis, according to the American College of Radiology 1, 5
MRI may be considered as a follow-up study, with superior soft tissue resolution for evaluating tumor invasion, as reported by the American College of Radiology 7
MRI can better characterize fistula formation, as noted by Gastroenterology 3

Back pain associated with diverticulitis typically worsens with movement or pressure on the abdomen, as reported by Gastroenterology 3
Back pain associated with diverticulitis may be accompanied by fever, leukocytosis, or elevated CRP, according to Gastroenterology 8
Back pain associated with diverticulitis often presents with concurrent abdominal pain, as noted by Gastroenterology 2

Colovesical fistula formation can occur when diverticulitis extends into the bladder, as reported by the American College of Radiology 6
Colovesical fistula formation may present with pneumaturia, fecaluria, or recurrent UTIs, according to the American College of Radiology 6
Colovesical fistula formation can be diagnosed on contrast-enhanced CT by identifying an enhancing tract between colon and bladder, as noted by the American College of Radiology 6

If diverticulitis is causing back pain, antibiotic treatment should be considered for complicated cases or patients with comorbidities, as recommended by Gastroenterology 4
Imaging-guided drainage may be needed for abscesses, according to the American College of Radiology 6
Colonoscopy should be performed 6-8 weeks after resolution of acute symptoms to exclude underlying malignancy, as recommended by Gastroenterology 3