Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with acute, severe, diffuse abdominal pain, fever, and signs of systemic inflammatory response syndrome (SIRS). History of localized diverticulitis progressing to generalized peritonitis. Reports nausea, vomiting, and obstipation. No prior history of similar acute surgical abdomen.
Clinical Examination Findings
Patient appears toxic, febrile, and tachycardic. Abdomen is rigid, distended, and diffusely tender with involuntary guarding and rebound tenderness. Bowel sounds are absent. Digital rectal exam reveals tenderness in the pouch of Douglas. Hemodynamic instability noted.
Treatment Protocol
Immediate resuscitation with IV fluids and broad-spectrum intravenous antibiotics. Urgent surgical consultation for exploratory laparotomy or laparoscopic lavage/resection (Hartmannโs procedure or primary anastomosis with diversion). NPO status, nasogastric tube decompression, and serial abdominal exams.