A middle aged woman w/ obesity who presents with sudden onset profuse diarrhea and SIRS. She was initially sent home after a CT was negative at her first ED visit, but represented two days later with worsening symptoms and temperature to 104. A CT was ultimately repeated with IV and PO contrast, and showed diverticulitis c/b contained perforation.
*The sensitivity and specificity of abdominal CT [with oral AND IV contrast] for the diagnosis of acute diverticulitis are 94 and 99 percent, respectively
*25% of patients with acute diverticulitis have associated complications – complications include bowel obstruction, abscess development, fistula, or a colonic perforation (as seen in this case)
*Indications for urgent surgery: failure of medical treatment, obstruction, abscess failing nonoperative intervention
Kaiser SF Internal Medicine Residency Blog 