Weight loss and fatigue are common. Pneumaturia, mucinuria, or fecaluria may occur when fistulization of the sigmoid colon to the bladder occurs secondary to diverticulitis or cancer. Bowel sounds may be normal early on but usually become quiet. Abdomen is hyperresonant to percussion. Palpation of the abdomen reveals tenderness.
Rebound tenderness is an ominous sign that implies peritonitis secondary to perforation.
Sigmoid diverticulitis and a perforated sigmoid secondary to carcinoma are clinically difficult to differentiate. Patients may have guaiac-positive stool if carcinoma is the etiology. Rectal or lower sigmoidal mass may be palpated on rectal examination. A mass or fullness may be appreciated if a tumor is present in the cecum. Intussusception commonly involves a tumor, which acts as the lead point, and is located at the ileocecal valve.