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Short answer question case series: controversies in the diagnosis and management of diverticulitis
  1. Josh Beck,
  2. Timothy B Jang
  1. Department of Emergency Medicine, David Geffen School of Medicine at UCLA, Harbor-UCLA Medical Center, Torrance, California, USA
  1. Correspondence to Dr Timothy B Jang, Department of Emergency Medicine, Harbor UCLA Medical Center, David Geffen School of Medicine at UCLA, 1000 W. Carson St., Torrance, CA 90509, USA; tbj{at}ucla.edu

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Case vignette

A 50-year-old man with no medical history presents with 2 days of left lower quadrant pain. He describes the pain as ‘achy’ and says that it began gradually and has been progressively worsening. He has had one episode of non-bloody diarrhoea but has not had any nausea or vomiting and denies any urinary symptoms. On examination, he is found to be afebrile with normal vitals signs and has only mild left lower quadrant pain.

Key questions

  1. What is the differential diagnosis for this patient?

  2. How should this patient be evaluated?

  3. How should this patient be treated?

  4. What is the appropriate disposition for this patient?

Discussion

1. Since the patient has left lower quadrant pain of subacute onset, the differential diagnosis should include diverticulitis, renal colic or testicular pathology. Also on the differential diagnosis, although less likely, would be prostatitis, pyelonephritis, atypical appendicitis and cancer.

2. The patient should undergo a thorough physical examination including a testicular and prostate examination. Laboratory studies should include a complete blood count, chemistry and urinalysis. A chemistry panel will give an indication of renal function, which may be required for obtaining a contrast-enhanced CT scan. The presence of an elevated white count may be useful when determining the ultimate treatment and disposition of the patient.

Historically, the evaluation of patients with suspected diverticulitis involved …

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