Review Question - QID 102680

This patient is presenting with left lower quadrant abdominal pain and fever which is concerning for diverticulitis. The most appropriate next step in management is a CT of the abdomen with IV contrast to confirm the diagnosis.

Acute diverticulitis typically presents in an elderly patient with a history of diverticulosis. Presenting symptoms can include decreased oral intake, fever, left lower quadrant abdominal pain/tenderness, and anorexia. Any patient with a suspected diagnosis of diverticulitis should receive a CT of the abdomen. Once the diagnosis is confirmed, the patient should be treated with antibiotics.

Incorrect Answers:
Answers 1-2: Ceftriaxone and metronidazole and ciprofloxacin and metronidazole are both appropriate antibiotic regimens for treating diverticulitis once the diagnosis has been confirmed with a CT. In this patient, it would be better to avoid ciprofloxacin given this patient has a ruptured Achilles tendon that was just repaired surgically.

Answer 3: Colonoscopy is contraindicated in the management of diverticulitis as it could perforate a diverticulum. For this reason, he should undergo a colonoscopy at some point after this infection is treated to rule out malignancy.

Answer 5: MRI abdomen is unnecessary for making the diagnosis of diverticulitis and the preferred imaging modality is a CT. MRI could be used in the diagnosis of appendicitis in a pregnant woman.

Bullet Summary:
The most appropriate initial step in management in diverticulitis is a CT scan of the abdomen.