Diverticular Disease with Unusual Presentations: A Case Series

Diverticular disease is a common colonic disorder in the elderly, most often presenting as diverticulitis or mild bleeding. On occasion, however, it manifests in unusual ways that mimic malignancy or genitourinary pathology, posing significant diagnostic challenges. We describe four patients with rare complications of diverticular disease: a colovesical fistula presenting with recurrent urinary tract infections, a stricture causing intestinal obstruction, massive lower gastrointestinal bleeding requiring embolisation, and a localised perforation simulating carcinoma that was managed by Hartmann’s procedure with later reversal. Cross-sectional imaging, particularly contrast-enhanced CT and CT angiography, was central to diagnosis. All patients underwent appropriate surgical or interventional management and recovered without perioperative mortality. This series emphasises the need for awareness of atypical presentations, timely use of imaging, and individualised treatment strategies in complicated diverticular disease.