EM:RAP 2018 September

Hi guys,

For this segment it would be helpful to know who needs and outpatient referral to a surgeon specific to the number of times they have had diverticulitis. I had been under the impression two diagnosis = referral to a surgeon and likely outpatient surgery. I am not sure if the standards had changed, and I know that Kenji had mentioned a lot has changed with diverticulitis.

Also are there any clinical rules, aside from discussion with radiology, to determine the effect of IV contrast administration despite an elevated creatinine?

Thanks for another great segment!

From Kenji Inaba:

Great comment.

For diverticulitis, the old adage that two episodes of uncomplicated diverticulitis should be followed by elective colectomy is not backed by any sound data. The decision to perform an elective resection should be individualized to the patient, and take into account their disease severity, age, underlying health status, access to medical care and personal preferences. Practically, this will require an in depth discussion with the patient. So anyone being discharged from the Emergency Department after an episode of acute diverticulitis, without a surgical consult, would benefit from outpatient follow-up with either their primary care physician or a surgeon if they have seen one previously, to discuss next steps.

As for the IV contrast in the face of known renal dysfunction, yes, planning is best done with radiology to discuss both risk mitigation strategies and timing as well as other diagnostic modalities that could be used without the need for contrast. This is the first place I go to when I have a patient like this!

Hope that helps!

Hi,

I've had a patient come in for her 5th acute diverticulitis attack in the span of only a couple years. The diagnosis was confirmed by CT on all previous episodes, and she has had a normal colonoscopy.

Thus I was wondering if, for a patient who has had confirmed diverticulitis in the past with similar symptoms and is low risk for complications, is it acceptable to simply treat based on clinical suspicion without imaging or if CT is required every time to confirm diagnosis. The major point for me is trying to minimise radiotion exposure in a patient who has had many CTs in the past.

Thank you!