Kamsi
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A 44-year-old previously healthy man is admitted to the hospital with a 3-day history of abdominal pain that initially started as a diffuse pain, and later became constant and severe, localized to the left lower quadrant. He also had nausea, vomiting, and a fever of 38.3 C (101.0 F). His past medical history is remarkable for an appendectomy at the age 9, and a hernia repair at the age of 20. Both surgical procedures were uneventful, and he was discharged home on the next postoperative day. On admission to the hospital, his temperature is 38.1 C (100.6 F), blood pressure is 140/80 mm Hg, and pulse is 90/min. Abdominal examination shows a distended, soft abdomen with tenderness and fullness in the left lower quadrant. Rectal examination does not reveal any abnormalities. A nasogastric tube is inserted and drains 400 ml bilious material. Laboratory studies show a leukocyte count of 18,000/mm3. Abdominal x-ray shows 6-7 air fluid levels with no free air. A CT scan of the abdomen and pelvis, performed on the day of admission to the hospital, confirms diverticulitis localized to the sigmoid colon with no abscess or free air. He is started on intravenous antibiotics and kept nil per os. Over the next few days, his temperature normalizes and his pain resolves with intravenous antibiotics. The most appropriate management of this patient is to
A. order a barium enema
B. perform a colonoscopy
C. recommend an elective sigmoid colon resection
D. repeat a CT scan of the abdomen and pelvis in 1-week
E. switch him to oral antibiotics
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| Doc750
transfer:step 3 prison
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C
(maybe E)
but I go with C
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| starcraftbw
Forum Senior
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very good question.......i hope it's not from NBME 
D (to r/o abscesses)
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| Justice
Forum Guru
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E. switch him to oral antibiotics
C-for frequently recurring episodes
starcraftbw wrote:
D (to r/o abscesses)
It was already excluded on a day of admission
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| Doc750
transfer:step 3 prison
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if diverticulits occurs in a younger patient, then recurrnce frequency is a lot higher, which is why you go with elective resection right away before the antibiotics. Vs an older patient with his first occurance of diverticulits, then just put him on antibiotics and hope it doesn't happen again, cause you don't want to put the old man under the knife unless you absolutely have to.
what's the answer???
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| njcjzy
Forum Guru
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I would think E. But Doc750 gave a reasonable explanation.
So what's the right answer, kamsi?
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| sherry39
Forum Junior
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i think its D ....coz it was obstruction before and barium enema or colonoscopy relatively contraindicated in obstruction...and after hearing.,gut sounds u can feed or give oral antibiotics...anyone plz help 
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| dr9576
Forum Newbie
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B
For a stablized diverticultis, after acute attack should go for a colonoscopy.
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| arlete
Intern in 2009!!!!!
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C.
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| Miradautas Vras
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I'd go for E
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| Ivonne
Going for step 3/99
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E he is getting better and eventually ready to go home.
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| khiladi
Forum Newbie
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According for First Aid CCS, colonoscopy is performed four weeks after recovery and sigmoid resection is reserved for cases refractory to antibiotics. So the answer is E
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| liliaeliz
Forum Elite
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e
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