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Chapter 8 ♦ Lower Gastrointestinal Disorders

symptoms or signs of inflammation may receive outpatient treatment with broad-spectrum antibiotics. On this management, the patient exhibits rapid improvement and becomes hungry. Q: What would the management plan be now? A: Management may entail a high-fiber diet, which is recommended after recovery from the initial attack. If afebrile, the patient can be discharged. Outpatient treatment with broad-spectrum antibiotics is appropriate for 7–10 days. Q: What is the likelihood that this patient will have another episode of diverticulitis? A: The recurrence rate is high and may be up to 40% but can be decreased with a high-fiber diet. Q: What long-term follow-up is necessary? A: Colonoscopy or barium enema may be appropriate after the patient has recovered to confirm the presence of diverticula and the absence of colon cancer ( Fig. 8-33 ).

Figure 8-33: Barium enema showing multiple diverticula. (From McKenney MG, Mangonon PC, Moylan JA, eds. Understanding Surgical Disease: The Miami Manual of Surgery . Philadelphia: Lippincott-Raven; 1998:154.) SAMPLE