ACUTE ABDOMEN • SENIOR RESIDENT / SURGEON

Acute Diverticulitis

The key decision is not whether diverticulitis exists, but whether abscess, free perforation, fistula, obstruction or sepsis changes management.

PROTOTYPE REVIEW REQUIRED

The Call

45-year-old man with left lower quadrant pain

Several days of left lower quadrant pain, constipation, fever and chills. CT demonstrates sigmoid diverticula with pericolonic inflammation.

T 38.5 C • HR 102 • BP 126/74

CT defines the complication profile and therefore drives treatment.

Read the Image • Clinical Data

CT Abdomen/Pelvis Use the archived diverticulitis imaging showing sigmoid inflammation, abscess or free perforation. Clinical image slot reserved for this case.

Make the Decision • Commit to a Plan

Acute Diverticulitis

45-year-old man with left lower quadrant pain

A stable patient has sigmoid diverticulitis with a 5-cm pelvic abscess accessible to IR and no diffuse peritonitis. Best initial strategy?

A different patient presents with free perforation, feculent peritonitis and septic shock. Which principle should guide the operation?

POD 4 after sigmoid resection the patient has new tachycardia, ileus and rising CRP. Best next step?

Control the septic source and choose reconstruction based on physiology.

Postoperative planning depends on the index disease and reconstruction.

Surgical Pearls

Pitfalls

A stable patient has a drainable pericolic abscess without diffuse peritonitis. Which principle best applies?