Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with acute onset of severe, diffuse abdominal pain, associated with high-grade fever, nausea, and vomiting. Symptoms progressed rapidly from localized LLQ pain to generalized peritonitis. Patient reports obstipation and inability to pass flatus. History significant for known diverticular disease. Current presentation consistent with Hinchey IV diverticulitis (fecal peritonitis).
Clinical Examination Findings
General: Patient appears toxic, diaphoretic, and in acute distress. Vitals: Tachycardic, febrile, hypotensive. Abdomen: Rigid, board-like abdomen with diffuse rebound tenderness and guarding. Absent bowel sounds. Digital Rectal Exam: Reveals fecal matter in the vault, extreme tenderness. Signs of systemic inflammatory response syndrome (SIRS) present.
Treatment Protocol
Immediate resuscitation with aggressive IV fluid therapy. Broad-spectrum IV antibiotics initiated. NPO status. Nasogastric tube for decompression. Urgent surgical consultation for exploratory laparotomy and source control (Hartmannโs procedure or resection with primary anastomosis depending on stability). ICU admission for hemodynamic monitoring.