DISCUSSION
The patient had acute sigmoid diverticulitis with associated pericolonic phlegmon/early abscess formation and evidence of microperforation. The remainder of the GI tract was unremarkable.
Treatment The patient was instructed to go to the emergency department for further evaluation and treatment. She was started on IV ciprofl oxacin and metronidazole and was to have nothing by mouth for 2 days. As she improved clinically, her diet was advanced to clear liquids. On day 4 of her hospitalization, a follow-up CT of the abdomen and pelvis showed sigmoid diverticulitis with associated phlegmonous collection. A well-defined abscess was not seen at that time. She was placed on a low-residue diet.
After 7 days of hospitalization, she was discharged on oral ciprofloxacin, 500 mg twice a day, and metronidazole, 500 mg three times a day. Discharge instructions included follow-up with her gastroenterologist and a surgical evaluation for colon resection. The patient returned to our office and reported that the antibiotic course would be completed the following day. She was pain free but having frequent nonbloody loose bowel movements despite adhering to a low-residue diet. Based on her last CT scan, an additional week of oral antibiotics was prescribed. Follow-up CT of the abdomen and pelvis was ordered, as well as stool studies for Clostridium difficile. She was instructed to follow up with the surgeon.
Comment Diverticulitis represents a spectrum of inflammatory changes involving colonic diverticuli that range from subclinical inflammation to peritonitis to free perforation.1 Patients with uncomplicated diverticulitis typically present with leukocytosis, a change in bowel habits, and pain in the left lower quadrant as the disease most commonly involves the sigmoid colon. More severe cases may manifest with the development of a phlegmon, abscess formation, fistulization, or generalized peritonitis. Diagnosis is confirmed by CT of the abdomen and pelvis.
Patients have been told to avoid eating nuts, corn, popcorn, and seeds to reduce the risk of complications associated with diverticulosis. However, results of a cohort study suggest that nuts, corn, and popcorn consumption was not associated with an increased risk of diverticulitis or diverticular bleeding and may be protective against developing diverticulosis.2 JAAPA
Corri Wolf is on the faculty of the Department of Physician Assistant Studies, New York Institute of Technology, Old Westbury, New York. The author has indicated no relationships to disclose relating to the content of this article.
Erich Fogg, PA-C, MMSc, department editor
REFERENCES
1. Ludeman L, Warren BF, Shepherd NA. The pathology of diverticular disease. Best Pract Res Clin Gastroenterol. 2002;16(4):543-562.
2. Strate LL, Liu YL, Syngal S, et al. Nut, corn, and popcorn consumption and the incidence of diverticular disease. JAMA. 2008;300(8):907-914.