Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with acute, severe abdominal pain localized to the LLQ, associated with high-grade fever, nausea, and vomiting. Symptoms are progressive, with signs of peritoneal irritation including guarding and rebound tenderness. History significant for known diverticulosis. Current presentation consistent with acute surgical abdomen secondary to suspected perforated diverticulitis.
Clinical Examination Findings
Patient appears toxic, febrile, and tachycardic. Abdominal examination reveals diffuse or localized peritonitis, marked tenderness to palpation, involuntary guarding, and rebound tenderness. Bowel sounds are hypoactive or absent. Digital rectal exam may reveal pelvic tenderness or mass effect. Hemodynamic instability may be present in advanced Hinchey IV cases.
Treatment Protocol
Immediate resuscitation with IV fluids and broad-spectrum IV antibiotics covering gram-negative and anaerobic organisms. NPO status, nasogastric tube placement for decompression if indicated. Urgent surgical consultation for CT-guided drainage (Hinchey III) or emergency surgical intervention (Hartmannโs procedure or primary resection with anastomosis) for Hinchey IV/peritonitis.