Kanchi Mehta
A 38yo male with history of diverticulitis complicated by sepsis presented to the ED with lower quadrant abdominal pain. He noted that the pain started 2 weeks ago and became worse. He reported normal bowel movements in the morning, denied fever/chills, nausea, vomiting, or genitourinary symptoms. A recent colonoscopy was notable for moderate sigmoid diverticulosis and a 4mm sessile sigmoid polyp that was resected.
Past medical history: Diverticulitis, ADHD, eczema, insomnia, loose stools
No past surgical history.
Vitals: BP 107/65 | Pulse 73 | Temp 98 °F (36.7 °C) | Resp 18 | BMI 25.35 kg/m²
A bedside ultrasound was performed, and the following image was obtained:
Figure 1: Diverticula with bowel wall edema
Uncomplicated acute diverticulitis characteristics on ultrasound are:
- thickened bowel wall >5mm
- presence of diverticula with focal outpouching or bowel wall discontinuity
- noncompressible pericolic fat inflammation with hyperechogenic halo around bowel serosa
- sonographic tenderness with compression
Outcome:
General surgery was consulted for possible surgical evaluation, which was deferred after findings on CT noted to be non-surgical. Patient was sent home with ciprofloxacin 500mg BID for 7 days and metronidazole 500mg TID for 7 days. Patient was also educated on return precautions.
References:
- Nazerian P, Gigli C, Donnarumma E, et al. Diagnostic accuracy of point-of-care ultrasound integrated into clinical examination for acute diverticulitis: a prospective multicenter study. Ultraschall der Med 2021;42(6):614–22. English.
- Cohen A, Li T, Stankard B, et al. A prospective evaluation of point of care ultrasonographic diagnosis of diverticulitis in the emergency department. Ann Emerg Med 2020;76(6):757–66.
- Damewood, Sara et al. “Gastrointestinal and Biliary Point-of-Care Ultrasound.” Emergency medicine clinics of North America vol. 42,4 (2024): 773-790. doi:10.1016/j.emc.2024.05.006
- https://www.ultrasoundcases.info/cases/abdomen-and-retroperitoneum/gastrointestinal-tract/diverticulosis-and-diverticulitis/