Diagnose It Answer — August 24, 2026
ALL CLUES
A 63-year-old man reports left lower quadrant abdominal pain that has steadily worsened over two days, accompanied by nausea and a fever measured at home.
One similar episode two years ago that resolved with oral antibiotics. Chronic constipation managed with intermittent laxatives and a habitually low-fiber diet. No recent travel, no sick contacts, and no blood in the stool.
HR 98, BP 142/86, RR 18, Temp 38.2 °C, SpO2 98% on room air. He appears uncomfortable but is well perfused.
Focal tenderness in the left lower quadrant with voluntary guarding and a vague palpable fullness. No rebound tenderness and no rigidity. Bowel sounds are hypoactive. He reports urinary urgency but no dysuria.
WBC 14,800/µL. C-reactive protein 62 mg/L. Lactate 1.4 mmol/L. CT of the abdomen and pelvis with contrast shows sigmoid wall thickening to 8 mm, pericolic fat stranding, and a contained 2 cm phlegmon without free air or abscess.
Diverticulitis is inflammation of colonic outpouchings, most often in the sigmoid where luminal pressure is highest. Left lower quadrant pain with fever and leukocytosis is the classic triad, and nurses should think of it as the left-sided mirror of appendicitis. CT staging determines management: uncomplicated disease responds to bowel rest and antibiotics, while abscess, perforation, or free air demands surgical consultation. Assess continuously for rebound tenderness, rigidity, or a lactate rising above 2.0 mmol/L, since these signal perforation and peritonitis, a life-threatening progression requiring immediate escalation.
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