Diverticular Dee — Diverticulitis
LLQ pain, fever and a change in bowel habits — perforation turns this into peritonitis fast
Dee has had years of mild constipation and occasional cramping in her lower left abdomen that she never mentioned to anyone. Tonight the pain sharpens suddenly, she spikes a fever, and her abdomen feels tender and guarded to the touch.
Dee has small outpouchings (diverticula) in her colon wall, most often in the sigmoid colon, that form from years of low-fiber diet and chronic constipation. When stool becomes trapped in a diverticulum, inflammation and micro- or macro-perforation follow, producing diverticulitis. Classic presentation is left lower quadrant pain, fever, and altered bowel habits. Complications include abscess, fistula, obstruction and free perforation causing peritonitis.
Read Diverticular Dee's full story →The story arc
The setup
Dee, 68, has a long history of a low-fiber diet and chronic constipation, with occasional mild LLQ cramping she attributes to 'irritable bowel.'
The turn
Dee develops steady left lower quadrant pain, low-grade fever, and a change in bowel habits with nausea.
The crisis
Dee's fever rises to 39.2°C, her WBC count climbs to 16,000/mcL, and her abdomen becomes rigid with rebound tenderness, suggesting perforation.
The save
The nurse keeps Dee NPO, starts IV fluids and antibiotics, monitors vital signs closely, and prepares her for possible CT-guided drainage or emergency surgery if perforation is confirmed.
NCLEX study section — Diverticulitis
What this chapter is testing: the recognition cues, the numbers and the priority action.
Study section: Gastrointestinal & Renal
Take this chapter into practice questions on the same topic.