Diverticulitis Quiz: Ace Your Exams

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A 71-year-old man is brought to the emergency department for 6 hours of severe generalized abdominal pain and subjective fever. The patient reports a 2-day history of constipation and left lower quadrant abdominal pain that has been increasing in severity. One year ago, he had an episode of constipation and left lower quadrant abdominal pain that was treated with oral antibiotics. Past medical history is notable for hypertension. BMI is 34 kg/m². Temperature is 38.7 °C (102.6 °F), blood pressure is 90/52 mmHg, pulse is 120/min, respiratory rate is 20/min, and room air oxygen saturation is 97%. Abdominal examination is significant for absent bowel sounds and severe diffuse tenderness with rigidity and guarding. Laboratory studies show leukocytosis and elevated C-reactive protein and lactate levels. Which of the following is the best next step in management?

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Obtain an abdominal ultrasound

Administer IV antibiotics and admit to the hospital for observation

Administer IV fluids and refer for urgent surgical consultation

Obtain a CT scan of the abdomen and pelvis with oral and IV contrast

Administer oral antibiotics and discharge home with a follow-up appointment in 2-3 days