By vgreene, 8 December, 2020 Refer pt for surgical intervention if develops s sx of sepsis or systemic inflammatory response 2 3 other hemodynamic instability 3 or fails worsens w non operative tx2
By vgreene, 8 December, 2020 Consider percutaneous drainage if abscess 3cm2 3 4 5cm per WSES 4 due to high abx failure rate consider trial of abx alone vs surgical intervention if percutaneous drainage not clinically possible 4 Surgery is last resort for pt w abscess failing non surg
By vgreene, 8 December, 2020 Abx indicated for all complicated dz monitor for failure of non operative tx esp in immunocompromised pts refer for surgical intervention as last resort
By vgreene, 8 December, 2020 Determine if dz is complicated w presence of any of these on imaging fluid outside of colon air gas beyond colonic lumen abscess 1 3 4 stricture obstruction fistula4
By vgreene, 8 December, 2020 Perform imaging to confirm dx1 5 esp if not prev done per ESCP AGA or if dx uncertain per ACP CT is preferred 1st line imaging 1 4 contrast preferred by WSES AGA but not req d per ASCRS 95 sens spec w o contrast 4 US is an alternative can be used 1st line
By vgreene, 8 December, 2020 Labs helpful in initial eval uarr WBC is part of classic findings but nonspecific 1 2 4 pyuria on UA may indicate colo vesical fistula 4 uarr CRP or procalcitonin may be predictive of complicated diverticulitis4 ESCP disagrees 3 uarr fecal calprotectin ma
By vgreene, 8 December, 2020 Begin eval w H P 1 4 5 but don t rely on clinical presentation alone 1 3 classic findings include fever LLQ pain 4 fecaluria pneumaturia stool per vagina may indicate associated fistula4
