A 55-year-old man is hospitalized with a first attack of acute diveiculitis. He has acute left lower abdominal pain with a palpable tender mass just above the left. groin area. Steps in his management during the first 24 h after admission should include intravenous fluids and
Acute diveniculitis severe enough to warrant hospitalization requires intravenous fluid replacement and broad-spectrum antibiotic therapy. Morphine is a poor choice for analgesic because it increases intracolonic pressure and may aggravate the diveniculitis. Meperidine is a better choice because it decreases intraluminal pressure. Unless there is small bowel obstruction from a loop of intestine adherent to the inflammatory mass, a nasogastric tube is necessary. The patient should respond promptly to appropriate management. Emergency operation is not necessary. Once the process has subsided, colonoscopic examination or barium enema can be done electively.
Broad-spectrum antibiotic therapy
Diagnostic colonoscopy
Morphine as needed for pain relief
Nasogastric suction