Q; 72 year old male is admitted to ICU with sepsis, left lower quadrant (LLQ) pain and lower gastrointestinal (GI) bleed. Diagnosis of acute diverticulitis is made. Which of the following procedure should NOT be performed in this patient?
A) CT scan of abdomen
C) Ultrasound of LLQ
D) insertion of left femoral central line
E) Angiography of mesenteric vessel
Out of all the procedures or workup, colonoscopy in acute phase of diverticulitis can harm the patient with very high risk of perforation.
CT scan is required to establish the diagnosis (choice A). Ultrasound may have a low yield and may not be of help, but it is not contra-indicated (choice C) in acute diverticulitis. Lower body central line insertions are discouraged in general but are not contra-indicated (choice D). Angiography may be of help in case of massive bleeding to localize the site of bleeding (choice E).
Colonoscopy can be performed after few weeks of resolution of acute episode to rule out underlying malignancy.
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2.Sharma PV, Eglinton T, Hider P, Frizelle F. Systematic review and meta-analysis of the role of routine colonic evaluation after radiologically confirmed acute diverticulitis. Ann Surg 2014; 259:263.