Case 5: Management

Based on these findings, you make a diagnosis of Acute Uncomplicated Diverticulitis

What is the next best step in management of this patient?
Inpatient admission for intravenous antibiotics
Incorrect. Patients who merit admission have one or more of the following attributes: Age >70, high fever, peritonitis or severe abdominal pain, oral intake intolerance, significant leukocytosis, CT evidence of microperforation or phlegmon, significant comorbidities and immunosuppressive disorders, inability to return for follow up or previously failed outpatient treatment. 
Discharge with oral antibiotics
Incorrect. Although antibiotics were formerly a mainstay of treatment for both complicated and uncomplicated acute diverticulitis, the AGA now advises against routine use in patients with uncomplicated disease. Given this patient is afebrile and immunocompetent, you decide to monitor the patient off antibiotics.
Discharge without oral antibiotics
Correct! Current AGA guidelines advise against use of antibiotics for immunocompetent patients with uncomplicated disease, few comorbidities, and no evidence of sepsis.
Colonoscopy for further evaluation
Incorrect. In the acute phase of diverticulitis colonoscopic evaluation carries the higher risk for perforation.

Additional Management Recommendations: 

All patients should be advised to follow a clear liquid diet during the acute phase of diverticulitis with the goal of maximizing patient comfort. Patients who are unable to resume a normal diet in 3-5 days should follow up immediately. Follow up is ideally within 2-3 days of diagnosis and at most within 7 days. If symptoms are not improving, inpatient treatment should be considered.

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