# Situation: A 63-year-old man has had steady left lower quadrant (LLQ) pain for 2 days, a temperature of 38.2 °C, and a white blood cell (WBC) count of 14,000/mm³ (normal 4,500–11,000/mm³). A computed tomography (CT) scan shows uncomplicated sigmoid diverticulitis. He is admitted for oral antibiotics and observation because he lives alone. His son asks why a colonoscopy is not being done now to examine the colon. Which explanation is accurate?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=630383  
> language: ko  
> subject: Nursing Practice IV — Care of Clients with Problems in Nutrition and Gastrointestinal, Metabolism and Endocrine, Perception and Coordination

## 문제

Situation: A 63-year-old man has had steady left lower quadrant (LLQ) pain for 2 days, a temperature of 38.2 °C, and a white blood cell (WBC) count of 14,000/mm³ (normal 4,500–11,000/mm³). A computed tomography (CT) scan shows uncomplicated sigmoid diverticulitis. He is admitted for oral antibiotics and observation because he lives alone.

His son asks why a colonoscopy is not being done now to examine the colon. Which explanation is accurate?

## 보기

1. Colonoscopy waits until he has had a second attack
2. The inflamed wall could tear during the procedure **✔ 정답**
3. The bowel preparation would worsen the infection
4. The computed tomography scan has already excluded colon cancer

**정답: 2**

## 해설

Colonoscopy is avoided during acute diverticulitis because air insufflation and instrumentation can perforate the inflamed colon. When indicated, it is done about 6–8 weeks after the episode to exclude colorectal cancer.

## 심화 해설

Why colonoscopy is delayed
He has acute uncomplicated sigmoid diverticulitis confirmed by computed tomography (CT): left lower quadrant pain, fever of 38.2 °C, and a white blood cell count of 14,000/mm³. Colonoscopy is avoided during acute diverticulitis because air insufflation and instrumentation can perforate the inflamed colon. The accurate explanation for his son is that the inflamed wall could tear during the procedure. When colonoscopy is indicated, it is done after recovery, about 6–8 weeks after the episode, mainly to exclude colorectal cancer.

The mechanism of perforation risk
Diverticula are small outpouchings where the mucosa herniates through weak points in the muscular wall of the colon, most often in the sigmoid. In diverticulitis, one or more of these pouches becomes inflamed or develops a microperforation. The surrounding wall is swollen, friable, and thin. During colonoscopy, air or carbon dioxide is pumped in to distend the bowel so the lining can be seen, and the scope itself presses against the wall as it advances around bends. An inflamed, thinned wall cannot safely withstand this distension and pressure. A procedure-related perforation would convert uncomplicated disease into complicated disease with peritonitis or abscess, often requiring surgery. That is why CT, not endoscopy, is the imaging test of choice during the acute attack.

Why the other explanations are inaccurate
Waiting for a second attack is wrong: the timing of colonoscopy depends on recovery from the current episode, not on recurrence. The bowel preparation is not the main reason for delay; the decisive danger is perforation from insufflation and instrumentation. Saying the CT scan has excluded colon cancer is false and potentially harmful, because inflammatory thickening on CT can look similar to a tumor, and CT cannot reliably exclude a cancer. That is precisely why colonoscopy is arranged after recovery when indicated.

| Test | Timing | Purpose |
| --- | --- | --- |
| CT of the abdomen | During the acute attack | Confirms diverticulitis and detects abscess or perforation |
| Colonoscopy | About 6–8 weeks after recovery, when indicated | Excludes colorectal cancer and other lesions |

Nursing application
The nurse reinforces the explanation in simple terms: the colon is inflamed now, a scope and air could tear it, and the examination will be safer once healing is complete. The nurse also monitors for complications during admission, such as worsening pain, rising fever, peritoneal signs, or rectal bleeding, and reports them promptly.

Exam takeaway
Key point During acute diverticulitis, avoid procedures that increase intraluminal pressure or stress the bowel wall, including colonoscopy and barium enema. CT is used to diagnose; colonoscopy is deferred until after recovery.

## 임상 시나리오

Colonoscopy Timing in DiverticulitisWhy the scope waits until recovery
In acute diverticulitis, the inflamed sigmoid wall is swollen and fragile. Air insufflation and the advancing scope can perforate it, so colonoscopy is avoided during the attack.

CT confirms the diagnosis and detects abscess. When indicated, colonoscopy is done about 6–8 weeks after recovery to exclude colorectal cancer, which CT cannot rule out.

CautionDo not tell the family that CT has excluded cancer. Inflammatory thickening can mimic a tumor, which is why follow-up colonoscopy is planned.

## 핵심 개념

- **Diverticulitis** — Inflammation or microperforation of colonic diverticula, most often in the sigmoid colon, causing left lower quadrant pain and fever.
- **Air insufflation** — Pumping air or gas into the bowel during endoscopy to distend it for viewing.
- **Colonoscopy** — Endoscopic examination of the entire colon used to detect polyps, cancer, and other lesions.
- **Uncomplicated diverticulitis** — Diverticulitis without abscess, perforation, fistula, or obstruction.

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