Diverticulitis with Abscess MCQ — NEET PG Practice Question | NEETPGAI
Diverticulitis with Abscess
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A 58-year-old man with a 3-day history of left lower quadrant pain, fever (38.5°C), and leukocytosis (WBC 14,000/μL) undergoes CT imaging with oral and IV contrast. The scan shows sigmoid wall thickening with pericolonic fat stranding and the finding marked **B** in the diagram. Which of the following management steps is most appropriate for this patient?
A. IV antibiotics (ceftriaxone + metronidazole) and bowel rest; CT-guided percutaneous drainage if abscess >3–4 cm
B. Colonoscopy within 48 hours to exclude malignancy and assess diverticular disease
C. Oral ciprofloxacin + metronidazole as outpatient with no imaging follow-up
D. Immediate emergency surgery (Hartmann's procedure) without imaging-guided intervention
Explanation
Why option 1 is right
The structure marked B — a pericolic abscess with air-fluid level — represents Hinchey Stage I or II diverticulitis (localized abscess confined to the mesentery or pelvis). According to the ASCRS Practice Parameters 2020 and Harrison's 21e, the standard of care for abscess-complicated diverticulitis is IV antibiotics (ceftriaxone + metronidazole or piperacillin-tazobactam) combined with bowel rest. For abscesses >3–4 cm, CT-guided percutaneous drainage is the definitive intervention, allowing resolution without emergency surgery in most cases. This approach avoids the morbidity of immediate colostomy while controlling infection and inflammation.
Why each distractor is wrong
Option 2: Emergency surgery (Hartmann's procedure) is reserved for Hinchey Stage III (purulent peritonitis) or Stage IV (feculent peritonitis), or when percutaneous drainage fails or is not feasible. A localized pericolic abscess (Stage I–II) is managed conservatively with antibiotics and drainage first.
Option 3: Oral antibiotics without IV therapy and without imaging-guided drainage are inadequate for an abscess-forming diverticulitis. The patient has systemic signs (fever, leukocytosis) requiring IV antibiotics and hospitalization. Outpatient management is reserved for uncomplicated diverticulitis without abscess.
Option 4: Colonoscopy is contraindicated in the acute phase of diverticulitis due to the risk of perforation. It is deferred 6–8 weeks post-recovery to exclude malignancy. Performing it within 48 hours would be unsafe and inappropriate.
High-YieldNEET PG
Pericolic abscess in diverticulitis = IV antibiotics + percutaneous drainage (if >3–4 cm); colonoscopy only after recovery to rule out malignancy.
Harrison's 21e Ch 326; ASCRS Practice Parameters 2020
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