Diverticular Disease

A 58-year-old man from Delhi presents with acute lower abdominal pain in the left lower quadrant, fever (38.5°C), and leukocytosis (WBC 14,000/μL). On examination, he has localized tenderness and guarding in the left iliac fossa. CT abdomen shows segmental wall thickening of the sigmoid colon with pericolonic fat stranding and a small abscess (2 cm). He denies prior episodes. What is the most appropriate initial management?

A 72-year-old woman with a history of recurrent left-sided diverticulitis (3 episodes over 2 years) presents for elective surgical consultation. She is currently asymptomatic and on no medications. Colonoscopy 1 month ago was normal and excluded malignancy. CT abdomen shows chronic changes of diverticular disease in the sigmoid colon without acute inflammation. What is the most appropriate surgical recommendation?

A 58-year-old man from rural India presents with acute left lower abdominal pain, fever (38.5°C), and constipation for 3 days. On examination, he has localized tenderness and guarding in the left iliac fossa. Blood investigations show WBC 14,500/μL, CRP elevated at 85 mg/L. CT abdomen with IV contrast reveals a 4 cm inflamed diverticulum with pericolic fat stranding and a small loculated collection (2 cm) adjacent to the sigmoid colon. He is hemodynamically stable. What is the most appropriate management?

A 72-year-old woman with a history of recurrent diverticulitis (3 episodes in 2 years) presents with acute left lower abdominal pain, fever (39°C), and abdominal distension. On examination, she has generalized peritoneal signs with rebound tenderness and guarding. Abdominal X-ray shows pneumoperitoneum. CT abdomen confirms a perforated diverticulum with free air and purulent peritonitis. Her blood pressure is 100/65 mmHg, heart rate 110/min, and WBC 18,000/μL. After initial resuscitation, what is the most appropriate surgical approach?

In the classification of colonic diverticular disease, what is the defining characteristic that distinguishes Hinchey stage III from stage II?