Post-Diverticulitis Colon Evaluation — ESEGH MCQ

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Hard"Gastroenterology"Post-Diverticulitis Colon EvaluationESEGH

CT shows acute diverticulitis with a 4.5 cm pericolic abscess. The patient is stable, and the collection is safely accessible. What management should be considered alongside IV antibiotics?

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Correct answer: A — Image-guided percutaneous abscess drainage

The best answer is “Image-guided percutaneous abscess drainage”. NICE uses 3 cm as the threshold above which drainage or surgery should be considered, guided by anatomy and clinical course. “Immediate colonoscopy through the inflamed segment” is less appropriate because acute instrumentation increases perforation risk and does not drain the abscess “Discharge with dietary advice alone” is less appropriate because a sizeable abscess needs inpatient antimicrobial and source-control assessment “Elective colectomy without treating the acute sepsis” is less appropriate because the immediate priority is infection control “Long-term mesalazine monotherapy” is less appropriate because mesalazine does not drain or treat a diverticular abscess

Reference: NICE NG147 diverticular disease: https://www.nice.org.uk/guidance/ng147/chapter/Recommendations