A 72-year-old man with sigmoid diverticular disease presents with left iliac fossa pain and CT showing a 5 cm pericolic abscess without free perforation (Hinchey Stage II). The MOST appropriate initial management is:
- A Emergency Hartmann's procedure
- B CT-guided percutaneous drainage and IV antibiotics ✓
- C IV antibiotics alone
- D Laparoscopic lavage and drainage
Correct answer: B. CT-guided percutaneous drainage and IV antibiotics
Explanation
Hinchey Stage II (pericolic or mesenteric abscess) with an abscess >3 cm is best managed by CT-guided percutaneous drainage plus IV antibiotics, avoiding emergency surgery in an unprepared colon. Abscesses <3 cm may respond to antibiotics alone. Emergency resection (Hartmann's) is reserved for Hinchey III (purulent peritonitis) or IV (faecal peritonitis). Successful drainage allows interval elective sigmoid resection if recurrent diverticulitis occurs.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.