A 68-year-old woman presents to urgent care with worsening left lower quadrant abdominal pain for the past 2 days. She reports no nausea or vomiting but does have a lack of appetite. There is no diarrhea or blood in her stool. She has not traveled recently or been exposed to anyone who was sick. She has a history of diverticulosis diagnosed by colonoscopy 2 years ago but has never had diverticulitis. She has no other GI history. She also has hypertension and hyperlipidemia, for which she is taking lisinopril and atorvastatin.
On physical examination, her vital signs are normal. She has mild tenderness to palpation in the left lower quadrant, no rebound or guarding, normal bowel sounds, and no palpable masses. She has no costovertebral angle tenderness.
What is the most appropriate next step in the management of this patient?
- Refer this patient to the emergency department for IV antibiotics, pain control, and imaging.
- Start antidiarrheal medication and observe her for 3 hours in the clinic.
- Prescribe oral antibiotics and discharge home.
- Discharge this patient home with over-the-counter acetaminophen for pain, a clear liquid diet for 2 days, and instructions to schedule a follow-up appointment with her gastroenterologist.
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Correct Answer: d. Discharge this patient home with over-the-counter acetaminophen for pain, a clear liquid diet for 2 days, and instructions to schedule a follow-up appointment with her gastroenterologist.
You conducted a careful and thorough physical examination to determine the cause of this patient’s abdominal pain. Her symptoms were suggestive of an uncomplicated diverticulitis flare. Given her stable vital signs, absence of peritoneal signs, and relatively mild symptoms, you followed current evidence and guidelines that support not prescribing antibiotics for select patients with uncomplicated diverticulitis who are otherwise healthy and immunocompetent.
Your discharge instructions also included explicit return precautions should her symptoms worsen or fail to improve in the next 48 to 72 hours. You informed your patient that the clear liquid diet and analgesic will provide relief of her symptoms in the short term; however, you reminded her that improving her diet to include more fiber and a probiotic, being more active, and drinking more water will improve her long-term outcome.
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Tracey Davidoff, MD, FACP, FCUCM, has practiced Urgent Care Medicine for more than 15 years. She is Board Certified in Internal Medicine. Dr. Davidoff is a member of the Board of Directors of the Urgent Care Association and serves as Co-Editor-in-Chief of the College of Urgent Care Medicine’s “Urgent Caring” publication. She is also the Vice President of the Southeast Regional Urgent Care Association and a member of the editorial board of the Journal of Urgent Care Medicine. At EB Medicine, Dr Davidoff is Editor-In-Chief of Evidence-Based Urgent Care, and co-host of the Urgentology podcast.
