Emergency
Appendicitis & Diverticular Disease
Emergency

Appendicitis & Diverticular Disease

Imaging by age/pregnancy + treatment.

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◆Appendicitis

  • •Periumbilical pain migrating to RLQ + fever + anorexia + rebound at McBurney point
  • •Adult: CT abdomen/pelvis with contrast
  • •Child/pregnant: US first; MRI if non-diagnostic
  • •Lap appendectomy + perioperative abx
  • •Perforated with abscess (symptoms >5 days): IV abx + PCD → interval appendectomy 6–8 weeks
  • •Diffuse contamination/peritonitis: immediate surgery
  • •Pregnant + peritonitis: don't delay for imaging — proceed to surgery

◆Acute diverticulitis

  • •Older adult + LLQ pain + low-grade fever + leukocytosis
  • •CT: pericolic fat stranding, diverticula
  • •Uncomplicated: outpatient PO abx (cipro+metro or amox-clav) + clear liquids 7–10 days
  • •Complicated (abscess, perforation, fistula, obstruction): admit ± drainage ± surgery
  • •Colonoscopy 6–8 weeks AFTER acute episode resolves to rule out malignancy

◆Diverticular complications

  • •Colovesical fistula: pneumaturia + recurrent UTIs → CT with contrast; cystoscopy; surgical repair after infection control
  • •Diverticular hemorrhage: painless BRBPR in elderly (chronic NSAIDs)
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