gastrointestinal disorders/diverticulitis

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Question 1 / 3

683d163ec1b3f4bd827daccd

Surgery

gastrointestinal disorders

diverticulitis

Case History

A 45-year-old male presents to the urgent care clinic complaining of left lower quadrant abdominal pain for the past 36 hours. He describes the pain as constant, aching, and intermittently sharp, without radiation. He reports mild nausea but denies vomiting or significant fever, noting only some increased stool frequency recently. He has a history of diverticulosis diagnosed during a screening colonoscopy 3 years ago. On examination, his temperature is 37.5 0C (99.5 0F), blood pressure is 125/78 mm Hg, pulse rate is 72/min, and respiratory rate is 16/min. His BMI is 28. Abdominal examination reveals localized tenderness to palpation in the left lower quadrant without rebound tenderness, guarding, or a palpable mass. An abdominal CT scan with oral and IV contrast performed earlier today revealed colonic wall thickening and stranding around the sigmoid colon consistent with diverticulitis, but no evidence of abscess, macroscopic perforation, or fistula. Given these clinical and imaging findings, what is the most likely diagnosis and the most appropriate initial management strategy?

Lab Parameter	Value	Reference Range
White Blood Cell Count	12.5 x 10^9/L	4.0-10.0 x 10^9/L
C-reactive protein (CRP)	45 mg/L	<10 mg/L
Hemoglobin	14.2 g/dL	13.5-17.5 g/dL
Serum Creatinine	0.9 mg/dL	0.6-1.2 mg/dL

A ) Acute complicated diverticulitis requiring immediate surgical consultation for emergent laparotomy and broad-spectrum intravenous antibiotics.

B ) Acute uncomplicated diverticulitis managed with outpatient oral broad-spectrum antibiotics, a clear liquid diet progressing to a low-residue diet, and close follow-up.

C ) Acute diverticulitis with suspected microperforation necessitating inpatient admission, intravenous antibiotics, bowel rest (NPO), and daily surgical evaluation.

D ) Inflammatory bowel disease exacerbation requiring colonoscopy for biopsy and initiation of systemic corticosteroids with close monitoring.

E ) Suspected diverticular abscess requiring percutaneous drainage under CT guidance and inpatient intravenous antibiotics followed by surgical resection.

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Question 2 / 3

683d163ec1b3f4bd827dacb5

Surgery

gastrointestinal disorders

diverticulitis

Case History

A 58-year-old woman presents to the emergency department with a 2-day history of worsening left lower quadrant abdominal pain, which started subtly but has become constant and severe. She reports associated subjective fevers, chills, nausea, and has experienced significant constipation for the past week, unusual for her. Her past medical history includes occasional constipation. She denies smoking or significant alcohol use. On examination, she appears acutely distressed. Vital signs are: Blood pressure 138/88 mmHg, pulse 102/min, respirations 18/min, and temperature 38.5 C (101.3 F). Her cardiovascular and respiratory exams are unremarkable. Abdominal examination reveals marked tenderness, guarding, and rebound tenderness in the left lower quadrant. A tender, ill-defined mass is palpable in the left iliac fossa. Rectal examination confirms significant tenderness in the left anterior rectal wall. Given the clinical findings, what is the immediate management strategy for this patient, and what serious complication should be closely monitored?

Lab Parameter	Value	Reference Range
White Blood Cell Count (WBC)	18.5 x 10^9/L	4.0-11.0 x 10^9/L
Neutrophils	85%	40-75%
C-reactive protein (CRP)	120 mg/L	<5 mg/L
Stool guaiac	Negative	Negative

A ) Acute appendicitis with atypical presentation; immediate laparoscopic appendectomy, monitoring for surgical site infection.

B ) Irritable bowel syndrome exacerbation; outpatient symptomatic management with fiber supplements and antispasmodics, monitor for chronic constipation.

C ) Acute diverticulitis with localized peritonitis; inpatient intravenous broad-spectrum antibiotics and bowel rest, close monitoring for progression to abscess or free perforation.

D ) Ulcerative colitis flare-up; high-dose oral corticosteroids and mesalamine, monitor for toxic megacolon.

E ) Complicated sigmoid volvulus; emergent endoscopic detorsion followed by elective sigmoid colectomy, monitor for bowel ischemia.

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Question 3 / 3

683d163ec1b3f4bd827daced

Surgery

gastrointestinal disorders

diverticulitis

Case History

A 58-year-old woman presents to her primary care physician's office complaining of recurrent left lower quadrant discomfort. She describes the pain as dull and aching, gradually worsening over the past 24 hours, now rated 6/10. She also reports low-grade fever, subjective chills, and mild nausea without vomiting. Her past medical history includes well-controlled hypertension and a known history of diverticulosis, diagnosed incidentally on a colonoscopy performed two years prior for screening. On physical examination, her temperature is 38.3°C, blood pressure is 128/78 mm Hg, pulse is 72/min, and respiratory rate is 14/min. Abdominal examination reveals mild distension, decreased bowel sounds, and tenderness to palpation in the left lower quadrant, with mild guarding but no rebound tenderness. Her stool guaiac test is negative. Urinalysis is unremarkable, showing no evidence of infection. Given her clinical presentation, what is the most likely diagnosis and the appropriate initial management strategy for this patient?

Lab Parameter	Value	Reference Range
Hemoglobin	125 g/L	120-160 g/L
Leukocyte count	14.5 x 10^9/L	4.0-10.0 x 10^9/L
Platelet count	280 x 10^9/L	150-450 x 10^9/L
C-reactive protein (CRP)	85 mg/L	<10 mg/L

A ) Suspected inflammatory bowel disease and immediate referral for colonoscopy with biopsies.

B ) Acute appendicitis and urgent surgical consultation for laparoscopic appendectomy.

C ) Acute uncomplicated diverticulitis, confirmed by contrast-enhanced abdominal CT scan, and initiation of oral antibiotic therapy with bowel rest.

D ) Complicated diverticulitis with suspected abscess formation, necessitating intravenous antibiotics and percutaneous drainage guided by abdominal ultrasound.

E ) Colonic ischemia requiring immediate serum lactate measurement and consideration of angiography.

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