ANSWERS TO CASE 26 Acute Sigmoid Diverticulitis
Summary: A 61-year-old man has 3 days of new-onset, worsening, left lower quadrant abdominal pain. He feels nauseated, and he has not had any bowel movements since the illness began. His temperature is 100.2°F and he has no pallor or jaundice. His abdomen is mildly distended with hypoactive active bowel sounds and marked left lower quadrant tenderness with voluntary guarding. Rectal examination reveals tenderness, and his stool is negative for occult blood. The WBC count is 11,800/mm3 with 74% polymorphonuclear cells, 22% lymphocytes, and a normal hemoglobin and hematocrit. A plain film of the abdomen shows no acute changes.
^ Most likely diagnosis: Acute sigmoid diverticulitis.
^ Most appropriate next step: Admit to the hospital for intravenous antibiotics and monitoring. CT scan of the abdomen will be very useful to confirm the diagnosis and to exclude pericolic abscess or other complications, such as fistula formation.
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