A 72-year-old woman presents with a 4-day history of lower abdominal pain, fever (38.4°C), and leucocytosis. CT abdomen and pelvis shows a 5 cm pericolic abscess adjacent to a segment of sigmoid colon with diverticular disease, with no free gas or free fluid. This is classified as Hinchey stage II diverticular disease. What is the most appropriate initial management?

• A Emergency Hartmann's procedure
• B Oral antibiotics and outpatient follow-up
• C Laparoscopic lavage and drainage without resection
• D Intravenous antibiotics and CT-guided percutaneous drainage of the abscess ✓

Explanation

Hinchey stage II disease (pericolic or pelvic abscess) is best managed initially with IV antibiotics combined with image-guided percutaneous drainage if the abscess is 3 cm or larger and technically accessible; this allows resolution of the acute episode in most cases. Emergency resection (Hartmann's) is reserved for failure of conservative management, peritonitis (Hinchey III/IV), or haemodynamic compromise. Oral antibiotics alone are insufficient for an abscess of this size. Laparoscopic lavage is primarily debated for Hinchey III (purulent peritonitis) and is not standard for stage II.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

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Written and medically reviewed by the StethoPrep medical team.