A 68-year-old male presents with severe left-lower quadrant (LLQ) pain. Vitals are remarkable for a temperature of 38.3 C. Labs are remarkable for a WBC count of 15,000. An abdominal CT scan shows a localized abscess of 2.5 cm near an inflamed diverticulum. What is the next step in the management of this patient?
- Oral antibiotics
2) IV antibiotics - CT-guided percutaneous drainage
- Laparotomy
- NPO, IV fluids, and observation
explanation
The patient in this vignette is suffering from complicated diverticulitis with abscess formation. IV antibiotics are the recommended initial treatment for abscesses < 3 cm.
Diverticulitis results from one or several inflamed or microperforated diverticula in the colon. It most commonly presents with LLQ pain, nausea and diarrhea or constipation. With increasing severity, the patient may become febrile with a leukocytosis. Complications include abscess and fistula formation, obstruction, and perforation. An abscess > 3cm is managed surgically with drainage, usually by interventional radiology.
Illustration A shows a diverticular abscess on CT.