A 78-year-old woman comes to the emergency department for left iliac fossa pain of 24 hours of evolution associated with fever and occasional vomiting. On examination, there is selective pain on palpation in the left iliac fossa with a feeling of occupation, defense and positive decompression. When acute diverticulitis is suspected, which of the following statements is correct?
Answer 1 is incorrect because the imaging tests of choice would be ultrasound or CT; answer 3 is incorrect because the laparoscopic approach is indicated from the start; answer 4 is incorrect because the indication in the first episode is for those under 50 years of age, in the rest it is indicated after the second episode or in cases of persistent symptoms or suspected neoplasia; and answer 5 is incorrect because surgery in cases of perforation with peritonitis should always resect the affected segment of colon to control the focus of the infection.
The safest and best performing complementary examination is the barium contrast enema.
In case of contained pelvic abscess, percutaneous drainage guided by CT or ultrasound is indicated.
If surgical intervention is required after resolution of the acute episode, the laparoscopic approach is contraindicated.
In case of acute uncomplicated diverticulitis, elective sigmoidectomy is indicated after cure of the first acute episode.
If generalized peritonitis occurs, the most appropriate surgical technique is the practice of a derivative colostomy without resection of the affected sigmoid segment.
Answer 1 is incorrect because the imaging tests of choice would be ultrasound or CT;
answer 3 is incorrect because the laparoscopic approach is indicated from the start;
answer 4 is incorrect because the indication in the first episode is for those under 50 years of age, in the rest it is indicated after the second episode or in cases of persistent symptoms or suspected neoplasia;
and answer 5 is incorrect because surgery in cases of perforation with peritonitis should always resect the affected segment of colon to control the focus of the infection.