Management of Acute Diverticulitis

Clinical Assessment and Diagnosis

The patient presents with classic signs of acute diverticulitis, including initial diffuse abdominal pain localizing to the left lower quadrant, fever, anorexia, nausea, constipation, and abdominal distention, which are consistent with the diagnosis of acute diverticulitis, as recommended by the World Journal of Emergency Surgery 1
Laboratory findings show leukocytosis and elevated C-reactive protein, consistent with inflammatory response in diverticulitis, according to the World Journal of Emergency Surgery 1, 3

NPO is necessary to rest the bowel and prevent exacerbation of inflammation, as indicated by the World Journal of Emergency Surgery 1, 3
IV fluid resuscitation is essential to correct potential dehydration from fever, poor oral intake, and third-spacing of fluids, as recommended by the World Journal of Emergency Surgery 1, 3
IV antibiotics are indicated due to the presence of fever, elevated WBC count, and CRP, as well as CT findings showing bowel wall thickening and fat stranding, according to the World Journal of Emergency Surgery and Annals of Internal Medicine 1, 2

Broad-spectrum antibiotics covering gram-negative and anaerobic bacteria are recommended for patients with signs of systemic inflammation, as suggested by the World Journal of Emergency Surgery 1
Appropriate regimens include Piperacillin/tazobactam, Ertapenem, and Eravacycline, as indicated by the World Journal of Emergency Surgery 1

Close monitoring is essential for vital signs, serial abdominal examinations, laboratory markers, and clinical response to treatment within 48-72 hours, as recommended by the World Journal of Emergency Surgery 1, 3, 4

If the patient fails to improve with conservative management within 48-72 hours, reassessment with repeat imaging and possible surgical consultation would be warranted, according to the World Journal of Emergency Surgery 1, 3
Colonoscopy should be considered 6-8 weeks after resolution of symptoms if the patient has not had a recent high-quality colonoscopy, as recommended by Gastroenterology 5