Acute Diverticulitis

Case: Elizabeth aged 65 years presents to your GP clinic. She had abdominal pain for the last 1-2 days which is getting
worse now. She also feels nauseous but no vomiting. She has not experienced such pain in the past. She had hypertension
and Type 2 DM and is on regular Coversyl 5mg daily and metformin 1 gm BID. Elizabeth lives in an independent unit with
her elderly husband. Both her sons live interstate and visit them only on special occasions.

Task
a. Focused history (used Panadol and neurofen; dull LIF pain, does not go anywhere, feverish, bowel motions every
third day, no problems with waterworks; generally feels tired;
b. Physical examination (sick-looking, tired, mild dehydration, no jaundice, BMI is 23, PR: 96 regular, BP 100/70, T:
37.6, RR: 16, O2 98%, no distention, mild tenderness on the LIF, no masses/rebound/guarding/rigidity, bowel
sound is present; fecal matter is present on DRE; no bleeding, fissures or hemorrhoids)
c. Diagnosis and management advise

Features:
- Over 40 years of age with long-standing, grumbling, left-sided abdominal pain and constipation, but can have
irregular bowel habit.
- Occurs in less than 10% of patients with diverticular disorder
- Symptoms: acute onset of pain in the left iliac fossa, pain increased with walking and change of position, usually
associated with constipation
- Triad: acute pain + left-sided radiation + fever
- Signs: tenderness, guarding and ridigity in LIF, fever, may be inflammatory mass in LIF
- Investigations: FBE, ESR/CRP, pus and blood in stools, abdominal USD/CT scan (detect, fistula, abscess or
perforation), erect CXR, erect and supine abdominal xray
- Complications: Bleeding, perforation, abscess, peritonitis, fistula, intestinal obstruction
- Treatment:
o Admission
o Rest GIT
o Analgesics
o Antibiotics
Mild: Amoxicillin + Clavulanate TID x 7 days or Metronidazole + Cephalexin
Severe: Ampicillin 2g IV q6 + gentamycine 5-7 mg/kg IV/day + metronidazole OR
metronidazole + Ceftriaxone 1g IV/day
o Surgery for complications
o Screening colonoscopy after acute episode
- Refer husband to respite care/nursing home