This case involves a fifty-two-year-old woman who was admitted to the hospital due to complaints of bloody stool. Studies and samples were ordered which did not show any source for the bleed. A colonoscopy was performed which revealed blood throughout the colon. The patient appeared to have a pan-colonic diverticulosis. She underwent a placement of a venous catheter and a total abdominal colectomy, and an ileoproctostomy was performed. The surgery was completed and the patient appeared to be doing fine postoperatively. About one week after surgery, however, the patient developed a high fever. An exploratory laparotomy was ordered, as well as the drainage of an abscess. She was placed on moxifloxacin hydrochloride, but the patient died shortly thereafter because of multi-organ failure.
Question(s) For Expert Witness
- 1. What is the standard treatment for diverticulosis?
Expert Witness Response E-004465
The approach to the treatment of diverticulitis can be broadly classified into either uncomplicated disease or complicated disease, with a few other special considerations to take into account. Acute uncomplicated diverticulitis is successfully treated in 70-100% of patients with conservative management. Hospitalization is required with evidence of severe diverticulitis, such as systemic signs of infection or peritonitis. Patients who are unable to tolerate oral hydration, who fail outpatient therapy (ie, persistent or increasing fever, pain, or leukocytosis after two to three days), who are immunocompromised, or who have comorbidities may also require hospitalization. Pain may be severe enough to require parenteral narcotic analgesia. About 15-25% of patients presenting with a first episode of acute diverticulitis have complicated disease that requires surgery. According to the WGO 2007 guidelines, 15-30% of patients admitted for management of diverticulitis will need surgery during their admission, with an 18% surgical mortality rate.