A 55-year-old non-immunocompetent woman presents with left lower quadrant pain and fever. CT scan shows uncomplicated acute sigmoid diverticulitis with pericolic fat stranding but no abscess or perforation. According to current guidelines, what is the most appropriate initial management?

• A Inpatient intravenous antibiotics (piperacillin-tazobactam) and bowel rest
• B Outpatient management with liquid diet and close follow-up, without antibiotics ✓
• C Outpatient oral antibiotics (ciprofloxacin and metronidazole) for 7 days
• D Urgent sigmoid colectomy to prevent recurrence

Explanation

Current ASCRS and ACG guidelines recommend selective rather than routine use of antibiotics for acute uncomplicated diverticulitis. In immunocompetent patients without systemic signs of severe infection, outpatient management with dietary modification and close follow-up without antibiotics is safe and reduces antibiotic resistance. Surgery is reserved for complicated disease or recurrent episodes impacting quality of life.

Reference: Sabiston Textbook of Surgery: The Biological Basis of Modern Surgical Practice, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.