Diverticulitis, Acute


Step 1: View clinicals

A 62 year old woman presents with pain in the left lower abdomen for 6 hours. She also passed a moderate amount of bright red blood per rectum last night. There is no history of nausea, vomiting, dysuria, or diarrhea, and this is her first such episode. Her bowel habits have not changed recently. Her medical and family histories are unremarkable, and she is not on any medications.

Step 2: Order all relevant investigations

Complete Blood Count + CRP

WBC/DC: 13,000/mm3 (4,600-11,000) N: 80% L:15% Hb: 12.2 g/dL (11.0-18.0) Hct (PCV): 38% Platelets: 209,000/mm3 (150,000-400,000) C-reactive protein: 96 mg/L

Ultrasound Abdomen

The graded compression ultrasound scan of the abdomen reveals focal thickening of the walls of the sigmoid colon. No other abnormalities are noted.

Contrast CT Abdomen

There is focal thickening of the walls of the sigmoid colon, along with multiple diverticula. The arrowhead sign is noted in association with a diverticulum. There are no abscesses, or intra-abdominal free fluid or free air.

Colonoscopy in 72 hours

You realize that colonoscopy is best postponed until later.

Step 3: Select appropriate management

Vascular Surgical Referral
Oral Clear Fluids

Score: ★★☆