UKMLA PLAB AMC USMLE Prometric MCQ

A 50 year old man with pyrexia and left lower quadrant pain is found on CT to have evidence of a diverticular abscess in the pelvis. It measures 5cm in maximum diameter. This is typically managed by

a) resection of the sigmoid colon

b) chemotherapy and radiatiotherapy

c) CT guided drainage

d) transverse colectomy

e) internal sphincterotomy

Correct Answer: C

Explanation: When a diverticular abscess is identified on CT scan or ultrasound, percutaneous aspiration should be performed if the abscess is larger than 3cm. A pelvic abscess may be drained into the rectum. Smaller abscesses can be treated expectantly with intravenous antibiotics and observation. Most cases will resolve with the above treatment. Once the inflammation has subsided, resection of the diseased segment can be safely performed as a single-stage procedure. If, however, the patient fails to improve clinically, a Hartmann's procedure is required