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Acute diverticulitis — USMLE Step 2 CK MCQ

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HardInternal MedicineAcute diverticulitisUSMLE Step 2 CK

A 58-year-old man has 4 days of left-lower-quadrant pain and fever. CT shows sigmoid diverticulitis with a 4.6-cm pericolic abscess; there is no free perforation or diffuse peritonitis. Blood pressure is 124/72 mm Hg after fluids, and pain is controlled. Which initial management is most appropriate?

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Correct answer: E — Intravenous antibiotics plus image-guided percutaneous abscess drainage

The best answer is “Intravenous antibiotics plus image-guided percutaneous abscess drainage”. A stable patient with a diverticular abscess larger than 3 cm should generally receive antibiotics and image-guided percutaneous drainage when anatomically feasible. Antibiotics alone have a higher failure rate at this size. Free perforation, generalized peritonitis, instability, or failure of nonoperative therapy would favor surgery, none of which is present. Acute colonoscopy risks perforation and is deferred until inflammation resolves; outpatient oral therapy is inadequate for this complicated presentation.

Reference: ASCRS 2020 clinical practice guideline: left-sided colonic diverticulitis. https://pubmed.ncbi.nlm.nih.gov/32384404/