A 70-year-old female presents with acute severe lower abdominal pain and fever (38.8 C). Examination shows guarding in the left lower quadrant. Abdominal CT confirms acute colonic diverticulitis with localized wall thickening and pericolic fat stranding without abscess or perforation (Hinchey Stage Ia). What is the standard initial medical therapy?

Answer and explanation

Correct answer: D. Bowel rest, intravenous hydration, and broad-spectrum antibiotics covering Gram-negative and anaerobic bacteria

  1. Step 1: Uncomplicated acute diverticulitis (Hinchey Stage Ia) is managed conservatively with bowel rest, fluid resuscitation, and antibiotics covering bowel flora (e.g., Ciprofloxacin plus Metronidazole, or Ceftriaxone plus Metronidazole).
  2. Step 2: Consequently, the correct clinical answer is Bowel rest, intravenous hydration, and broad-spectrum antibiotics covering Gram-negative and anaerobic bacteria.
Answer
Bowel rest, intravenous hydration, and broad-spectrum antibiotics covering Gram-negative and anaerobic bacteria.
Why not the others: 'Hartmann procedure' is reserved for acute perforated diverticulitis with feculent peritonitis (Hinchey Stage IV); 'Immediate optical colonoscopy' is strictly contraindicated during acute diverticulitis due to the high risk of converting inflamed tissue into free colonic perforation; 'Oral high-fiber laxatives' exacerbate colonic intraluminal pressure during active inflammation.

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