Diverticular Abscess

Question 1

A 79 year-old woman is brought to the emergency department with severe pain and tenderness on the left side of her lower abdomen. She appears to be critically ill.

What are your differentials?

Answer 1

1. Diverticulitis or diverticular abscess, Gastroenteritis
2. Sigmoid volvulus → acute constipation
3. Ureteric Colic, UTI
4. Pelvic tumour

Question 2

Define Sepsis

Answer 2

Sepsis: Life-threatening condition characterised by organ dysfunction due to dysregulated host response to infection

Question 3

Define Shock

Answer 3

Shock: Life-threatening condition characterised by inadequate tissue perfusion resulting in unmet metabolic needs.

Question 4

Define Septic Shock

Answer 4

Septic shock: Sepsis + circulatory, cellular / metabolic abnormality evident by

1. persisting hypotension requiring vasopressors
2. Lactate >2

Question 5

Later on this patient developed anastomotic leakage. What is your Management?

Answer 5

• Taking down the anastomosis
• Hartman’s
  
  • proximal colon as an end colostomy
  • Closure of the rectal stump
• Good peritoneal washout and drainage
• HDU
• Abx micro

Question 6

How would you diagnosis and manage sepsis?

Answer 6

Quick Sequential Organ Failure Assessment

SOFA 2-3 high risk

Organ dysfunction is a score of 2 or more

Question 6

CT confirmed the presence of diverticular abscess, what are the management options?

Answer 6