Case Scenario: An 84- year-old -female who has a history of diverticular disease presents to the clinic with left lower quadrant (LLQ) pain of the abdomen that is accompanied by constipation, nausea, vomiting, and a low-grade fever (100.20 F) for one day.

Case Study-Diverticulitis

This scenario involves an 84-year-old female patient who reports to the clinic complaining of left lower quadrant pain in the abdomen for the past day. The patient has a history of diverticulitis. She also presents with constipation, nausea, low-grade fever (100.20 F), and vomiting. Physical examination reveals tachycardia and dehydration, as evidenced by pale mucosa, poor skin turgor, and mild hypotension (90/60 mmHg). An abdominal examination revealed distended NP notes, round contour, faint and very hypoactive bowel sounds, and hyper-resonance of the abdomen on percussion. Diagnostics revealed positive stool occult blood, no evidence of mass or abscess, distended small bowel, and a bowel gas pattern consistent with an ileus. The patient was diagnosed with acute diverticulitis and managed using intravenous antibiotics and fluids.

Diverticulitis

Diverticulitis is characterized by infection and inflammation in one or more diverticula, while diverticula in the colon characterize diverticulosis. Diverticulosis affects any part of the colon, mostly the left colon (Nallapeta et al., 2022). Diverticulosis leads to diverticulitis. Patients diagnosed with acute diverticulitis present with left lower quadrant pain that causes changes in bowel habits and cramps, fever, flatulence, bloating, constipation, nausea, vomiting, and obstipation (Linzay & Pandit, 2022). The clinical findings from the case that supported a diagnosis of acute diverticulitis include left lower quadrant pain, nausea, constipation, vomiting, and low-grade fever of 100.20 F. Results from the physical examination that supported a diagnosis of acute diverticulitis include localized abdominal tenderness, hypoactive bowel sounds, abdominal distention, abdominal pain, positive stool occult blood and bowel gas pattern suggesting an ileus.

Risk factors for acute diverticulitis include smoking, obesity, lack of exercise, and age. Individuals above 40 years of age have a 20% risk of suffering from diverticulosis, while those above 60 years have a 60% risk. The risk of diverticulitis is above 65% in individuals above 85 years (Linzay & Pandit, 2022). Smokers are more likely to experience diverticulitis than non-smokers. Medications such as non-steroidal anti-inflammatory drugs, opioids, and steroids increase the risk of diverticulitis. Low fiber and a high animal-fat diet increase the risk for diverticulitis. The patient was admitted to the hospital and managed as an inpatient. Inpatient management of acute diverticulitis includes intravenous fluids, pain management, and intravenous antibiotics (Linzay & Pandit, 2022). Acute diverticulitis presents with dehydration, hence the need to administer intravenous fluids. Antibiotic therapy is administered to fight infection. Broad-spectrum intravenous antibiotics are preferred before culture results are obtained. Monotherapy intravenous antibiotics administered include meropenem, imipenem, piperacillin-tazobactam, and ampicillin-sulbactam. Multiple intravenous antibiotics selection includes metronidazole, fluoroquinolone, metronidazole, and cephalosporin such as ceftriaxone.

References

Linzay, C. D., & Pandit, S. (2022). Acute Diverticulitis. StatPearls Publishing.https://www.ncbi.nlm.nih.gov/books/NBK459316/.

Nallapeta, N. S., Farooq, U., & Patel, K. (2022). Diverticulosis. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK430771/.