A 37-year-old woman presents with abdominal pain, anorexia, and fever of 4 days’ duration. The abdominal pain is mostly in the left lower quadrant. Her past medical history is significant for irritable bowel syndrome,diverticulitis treated 6 months ago, and status post-appendectomy. Since her last bout of diverticulitis she has increased her fiber intake and avoids nuts and popcorn. Review of systems is positive for weight loss, daily chills and sweats, and “bubbles” in her urinary stream. Her temperature is 39.6°C. A limited CT scan shows thickened colonic wall (5 mm) and inflammation with pericolic fat stranding. She is admitted with a presumptive diagnosis of diverticulitis. What is the most appropriate management for this patient? A. A trial of rifaximin and a high-fiber diet B. Bowel rest, ciprofloxacin, metronidazole, and ampicillin C. Examination of the urine sediment D. Measurement of 24-hour urine protein E. Surgical removal of the affected colon and exploration.
Posted on: Tue, 30 Dec 2014 22:57:38 +0000
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