Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with acute onset of left lower quadrant (LLQ) abdominal pain, associated with fever, chills, and localized peritoneal irritation. Symptoms are consistent with complicated diverticulitis. History of prior episodes noted. Denies hematochezia or signs of high-grade bowel obstruction. Current presentation suggests pelvic abscess formation (Hinchey II).
Clinical Examination Findings
Abdominal exam reveals significant tenderness in the LLQ with guarding and rebound tenderness. Bowel sounds are hypoactive. Digital rectal exam (DRE) may reveal a tender, fluctuant mass in the pelvic cul-de-sac. Vitals show tachycardia and febrile status. No evidence of generalized peritonitis or rigid abdomen.
Treatment Protocol
Admission for IV fluid resuscitation and broad-spectrum IV antibiotics covering gram-negative and anaerobic organisms (e.g., Piperacillin/Tazobactam or Ceftriaxone + Metronidazole). NPO status initiated. Interventional Radiology (IR) consultation requested for CT-guided percutaneous drainage of the pelvic abscess. Serial abdominal exams and monitoring of inflammatory markers (WBC, CRP).