Diagnosis of diverticulitis with hands and blood tests. Is it a good idea?

Clinical Scenario

A 66 yo man complains of left lower quadrant (LLQ) abdominal pain from 4/5 hours. The pain is described as crampy initially, than continuous, there is not vomit. Temperature is 37.5°C. Abdomen is treatable, with moderate pain and tenderness localized at LLQ , there is not history of prior abdominal surgery. 

ED US excluded the specter of an AAA.

WBC 13.000/μl

CPR: 51 mg/L

Probably this patient suffers of an acute diverticulitis. 

Is it an urgent imaging necessary to confirm the diagnosis? 

Conclusion 

The patient presented above has a high probability to have an acute non complicated diverticulitis, imaging tests have a little impact on disease’s management. 

Imaging is necessary when all 3 clinical features aren’t present, or when the patient is very ill and the suspect  of any complication is very high. 

On the other hand the absence of any of 3 clinical features isn’t useful to rule out an acute diverticulitis. 

Bibliography 

W.Lameris

A clinical decision rule to establish the diagnosis of acute diverticulitis at the Emergency Department. 

Dis Colon Rectum 2010 53 896-904

JRT Monson

Management of acute diverticulitis: is less more?

Dis Colon Rectum 2011 54 126-128

Ciro Paolillo

to be continued...