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Acute diverticulitis — MCCQE Part 1 MCQ

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ModerateAbdominal PainAcute diverticulitisMCCQE Part 1

62-year-old woman presents with left lower-quadrant pain and fever. CT shows uncomplicated sigmoid diverticulitis without abscess. Which of the following is the most appropriate next step?

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Correct answer: A — Treat with supportive care and selective antibiotics based on severity/comorbidity

Treat with supportive care and selective antibiotics based on severity/comorbidity is best because uncomplicated diverticulitis can often avoid routine antibiotics in selected patients. Discharge with reassurance and routine follow-up only is suboptimal because it underestimates acute or progressive risk; Treat symptomatically and defer definitive assessment is suboptimal because symptom control alone does not address the likely underlying diagnosis; Arrange non-urgent outpatient imaging in several months is suboptimal because delayed imaging is unsafe when the presentation has red flags; Start long-term corticosteroids without confirming the diagnosis is suboptimal because empiric steroids can obscure infection, malignancy or other diagnoses. Complicated disease requires drainage or surgery depending on abscess/perforation.

Reference: Canadian Association of Gastroenterology diverticulitis guidance