A 68-year-old woman presents with left lower quadrant pain that worsens with defecation. She describes the pain as “crampy” and says she has had mild constipation for the past few years. The patient denies any recent weight change or urinary symptoms. Her temperature is 37.8°C (100.0°F), pulse rate is 102/min, respiratory rate is 16/min, and blood pressure is 133/87 mm Hg. On physical examination, she has left lower quadrant abdominal tenderness. The laboratory results are:
| Hemoglobin | 13.2 mg/dL (normal 12.0-16.0 g.dL) |
| Hematocrit | 48% (normal 36-46%) |
| Leukocyte count | 16,000/mm³ (normal 4500-11,000/mm³) |
| Neutrophils | 89% (normal 54%62%) |
| Bands | 5% (normal 3%-5%) |
| Eosinophils | 0% (normal 1%-3%) |
| Basophils | 0% (normal 0%-0.75%) |
| Lymphocytes | 11% (normal 25%-33%) |
| Monocytes | 0% (normal 3%-7%) |
| Platelet count | 380,000/mm³ (normal 150,000–400,000/mm3) |
What is the most likely diagnosis in this patient?
Correct answer: Diverticulitis
General Feedback
Diverticulitis is the inflammation of one or more diverticula, usually on the left side in the sigmoid colon. These outpouchings of colonic mucosa are typically secondary to constipation (see image). It is seen in middle-aged and older adults. Patients usually present with fever, nausea, diarrhea or constipation, bloating, flatulence, and lower left quadrant pain that worsens with defecation. The severity of symptoms depends on the extent of the infection and associated complications. Although diverticulitis most commonly occurs on the left side, right-sided diverticulitis is often confused with acute appendicitis.
A 68-year-old woman presents with left lower quadrant pain that worsens with defecation. She describes the pain as “crampy” and says she has had mild constipation for the past few years. The patient denies any recent weight change or urinary symptoms. Her temperature is 37.8°C (100.0°F), pulse rate is 102/min, respiratory rate is 16/min, and blood pressure is 133/87 mm Hg. On physical examination, she has left lower quadrant abdominal tenderness. The laboratory results are:
| Hemoglobin | 13.2 mg/dL (normal 12.0-16.0 g.dL) |
| Hematocrit | 48% (normal 36-46%) |
| Leukocyte count | 16,000/mm³ (normal 4500-11,000/mm³) |
| Neutrophils | 89% (normal 54%62%) |
| Bands | 5% (normal 3%-5%) |
| Eosinophils | 0% (normal 1%-3%) |
| Basophils | 0% (normal 0%-0.75%) |
| Lymphocytes | 11% (normal 25%-33%) |
| Monocytes | 0% (normal 3%-7%) |
| Platelet count | 380,000/mm³ (normal 150,000–400,000/mm3) |
What is the most likely diagnosis in this patient?
Correct answer: Diverticulitis
General Feedback
Diverticulitis is the inflammation of one or more diverticula, usually on the left side in the sigmoid colon. These outpouchings of colonic mucosa are typically secondary to constipation (see image). It is seen in middle-aged and older adults. Patients usually present with fever, nausea, diarrhea or constipation, bloating, flatulence, and lower left quadrant pain that worsens with defecation. The severity of symptoms depends on the extent of the infection and associated complications. Although diverticulitis most commonly occurs on the left side, right-sided diverticulitis is often confused with acute appendicitis.