A healthy 65-year-old woman presents to the emergency department with a 12-hour history of sudden-onset severe lower abdominal pain. This is her first episode. She reports nausea, vomiting, and anorexia. Her last colonoscopy was at age 60, and was normal, except for diverticulosis of the sigmoid colon. Physical examination is significant for fever, tachycardia, and generalized abdominal pain with rebound tenderness. Pertinent laboratory findings include a leukocytosis and metabolic acidosis. A CT scan is obtained and is consistent with freely perforated diverticulitis, including a thickened sigmoid colon, free fluid in the pelvis, and free air noted near the diaphragm (Fig. 1). The surgeon completes the patient evaluation, recommends initiation of intravenous fluid resuscitation and antibiotics, and plans to go immediately to the operating room for surgical resection.
1 Department of Surgery, University of North Carolina, Chapel Hill, North Carolina
2 Division of Gastrointestinal Surgery, University of North Carolina, Chapel Hill, North Carolina
Earn Continuing Education (CME) credit online at cme.lww.com. This activity has been approved for AMA PRA Category 1 Credit.TM
Financial Disclosure: None reported.
Funding/Support: Dr Lumpkin completed this work during for her postdoctoral research fellowship, for which she received 2 sources of support. This project was supported by grant F32HS026363 from the Agency for Healthcare Research and Quality. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality. This project was also supported by the Research Foundation of the American Society of Colon and Rectal Surgeons, General Surgery Resident Research Initiation Grant GSRRIG 042.
Correspondence: Stephanie T. Lumpkin, M.D., University of North Carolina, Department of Surgery, 4001 Burnett-Womack Bldg CB #7050, Chapel Hill NC 27599-7050. E-mail: Stephanie.email@example.com