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ORIGINAL CONTRIBUTIONS: SMALL BOWEL

Continuing Medical Education Questions: November 2015

Cheatham, Joseph G MD

Author Information
American Journal of Gastroenterology: November 2015 - Volume 110 - Issue 11 - p 1597
doi: 10.1038/ajg.2015.351
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Questions:

  1. A 38-year-old white male presents in your outpatient clinic after hospital discharge. He was admitted with subacute onset of left lower quadrant pain, fever, and a white blood cell count of 13,000/mL. A computed tomography (CT) scan confirmed his second episode of uncomplicated diverticulitis. He has finished his antibiotics.Which one of the following recommendations is most consistent with the natural history of diverticulitis?
    • A. Colectomy, as he is at an increased risk for recurrent uncomplicated diverticulitis.
    • B. Colectomy, as he is at an increased risk for recurrent diverticulitis with complications.
    • C. No colectomy, as uncomplicated diverticulitis almost always resolves itself over time and does not often recur.
    • D. No colectomy, as he is at increased risk for recurrent uncomplicated diverticulitis but at low risk for complicated diverticulitis.
  2. A 72-year-old white female with known sigmoid and descending colon diverticulosis presents with 18 hours of left lower quadrant pain that did not respond to acetaminophen. She presented to the emergency department when she developed a fever of 101°F. On initial evaluation she is slightly tachycardic with heart rate of 105 bpm and blood pressure of 156/89 mm Hg. Her abdomen is distended with hypoactive bowel sounds and rebound tenderness in the left lower quadrant. Abdominal/pelvic CT scan with IV and oral contrast reveals marked sigmoid inflammation, fat stranding, intramural abscess with a small amount of regional free air and proximal colonic wall dilation to 12 cm.According to this study, this patient's complicated diverticulosis puts her at increased risk for which one of the following outcomes?
    • A. Recurrent complicated diverticulitis
    • B. Nonsurgical management
    • C. Death
    • D. Colonic fibrotic stricture
  3. A 32-year-old white female with clinically diagnosed diverticulitis presents for follow-up. She was diagnosed without imaging and treated by her primary care provider 10 days ago after developing subjective low-grade fever and left-sided abdominal pain. Her white blood cell count at the time of diagnosis was at the upper limit of normal. Her pain and subjective fevers have resolved with antibiotics.Which one of the following statements most accurately describes your conclusion regarding this patient?
    • A. She is unlikely to have recurrent diverticulitis because of her young age.
    • B. She is at a lower risk for recurrent diverticulitis compared with those with CT-proven diverticulitis.
    • C. She is at a higher risk for recurrent complicated diverticulitis.
    • D. You cannot be sure that she has diverticulitis, because diagnosis without CT is unreliable.
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