# A 45-year-old patient is admitted to the medical unit with suspected diverticulitis. Which assessment finding would be most indicative of acute diverticulitis?

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## 문제

A 45-year-old patient is admitted to the medical unit with suspected diverticulitis. Which assessment finding would be most indicative of acute diverticulitis?

## 보기

1. Cramping pain in the right upper quadrant with nausea
2. Severe epigastric pain radiating to the back
3. Diffuse abdominal pain with frequent loose stools
4. Left lower quadrant pain with fever and leukocytosis **✔ 정답**

**정답: 4**

## 해설

Left lower quadrant pain with fever and leukocytosis is the classic triad of acute diverticulitis, indicating inflammation of the diverticula with possible infection. Diverticulitis is a condition where the diverticula, small pouches that form in the wall of the large intestine, become inflamed, and the pain is typically localized to the left lower abdomen (sigmoid colon). Fever and leukocytosis indicate infection and an inflammatory response. Analysis of incorrect answers: 1) Right upper quadrant cramping pain and nausea suggest cholecystitis or liver problems. 2) Severe upper abdominal pain radiating to the back is characteristic of pancreatitis. 3) Generalized abdominal pain and frequent loose stools may indicate infectious enteritis or irritable bowel syndrome.

## 심화 해설

Clinical Presentation of Acute Diverticulitis

The hallmark presentation of acute colonic diverticulitis, particularly in Western populations, is the development of localized inflammation in the sigmoid colon. This anatomical predilection explains why the pain is typically described as left lower quadrant (LLQ) pain. The pathophysiology involves the perforation of a colonic diverticulum, leading to micro- or macro-perforation and subsequent inflammation of the pericolic fat and mesentery. This localized inflammatory process triggers a systemic response, manifesting as fever and a laboratory finding of leukocytosis (elevated white blood cell count). The American College of Gastroenterology (ACG) guideline emphasizes that the diagnosis is often suspected based on this classic triad in a patient with known diverticulosis, though confirmation via imaging is essential, particularly at the first presentation [1].

The other options describe clinical scenarios more consistent with different abdominal pathologies. Cramping right upper quadrant pain with nausea (Option 1) is a classic presentation for acute cholecystitis or biliary colic. Severe epigastric pain radiating to the back (Option 2) is the hallmark of acute pancreatitis. Diffuse abdominal pain with frequent loose stools (Option 3) is more suggestive of infectious gastroenteritis or inflammatory bowel disease rather than a localized inflammatory condition like diverticulitis. The localized nature of the inflammation in diverticulitis typically does not cause diffuse pain or diarrhea as a primary feature, unless a complication such as a fistula or abscess has developed. A prospective imaging study comparing ultrasonography and computed tomography (CT) for suspected acute left colonic diverticulitis confirms that patient selection is based on this very specific clinical presentation of localized left-sided pain [2].

While diverticulitis is rare in the pediatric population, the diagnostic challenge in atypical age groups lies in its nonspecific presentation, which can mimic appendicitis [3]. In the classic adult patient, however, the combination of LLQ pain, fever, and leukocytosis remains the most indicative assessment finding. The ACG guideline reinforces that a CT scan is the gold standard for confirming the diagnosis, assessing severity, and ruling out complications such as abscess or perforation [1].

References (research sources)

- [1]ACG Clinical Guideline: Colonic Diverticulitis.GuidelinePeery AF, Strate LL, Stollman N, Mankaney G, Chang JW, Grover S. (2026) · DOI: 10.14309/ajg.0000000000004047

- [2]Ultrasonography for suspected mild-to-moderate acute left colonic diverticulitis: a prospective head-to-head study with computed tomography.Research articleRoson N, Antolin A, Flores-Yelamos M, Garriga MV, Pruna X, Pedraza S, Lopez-Cano M, Badia JM. (2026) · DOI: 10.3389/fradi.2026.1829813

- [3]Pediatric colonic diverticulitis: clinical presentation, management, and review of the literature.Research articlePistone M, Bosisio M, Wennemann L, Tohmasi S, Zani A, Zani-Ruttenstock E. (2026) · DOI: 10.1007/s00383-026-06521-4

## 임상 시나리오

Acute Diverticulitis AssessmentRecognizing the Classic Clinical Triad
Suspect acute diverticulitis in a patient with known diverticulosis presenting with the classic triad of left lower quadrant (LLQ) pain, fever, and leukocytosis (WBC > 10,000-12,000/mm³). The sigmoid colon is the most common site in Western populations.

The pain is typically constant and localized due to micro- or macro-perforation of a diverticulum causing pericolic inflammation. A systemic inflammatory response triggers the fever and elevated white count.

CautionDo not rely solely on the triad for a new diagnosis. CT scan of the abdomen/pelvis with IV contrast is the gold standard to confirm the diagnosis, assess severity, and rule out complications like abscess or free perforation.

## 핵심 개념

- **Diverticulitis** — Inflammation or infection of small pouches (diverticula) that form in the lining of the digestive system, most commonly in the sigmoid colon.
- **Leukocytosis** — An elevated white blood cell count, indicating an immune response to infection or inflammation.
- **Sigmoid Colon** — The S-shaped last part of the large intestine, leading into the rectum; the most common site for diverticulitis in Western populations.

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