Making Emergency Surgical Decisions Without any Imaging Evidence: A Case Report of Complicated Diverticular Phlegmon

Acute left-sided diverticulitis is the third most common gastrointestinal disease after acute pancreatitis and cholecystitis requiring hospitalization. From those patients, 15% to 20% were diagnosed with abscess on the computed tomography (CT) scan. Usually, abscess larger than 5 cm are not amenable for medical treatment. A 61-year-old woman presented to emergency department of the general hospital in the remote island with 48-h history of fever, tachypnea, and tachycardia. Physical examination revealed 15 × 7 cm mass occupying the left mid-abdomen and iliac fossa. Patient did not report any unintentional loss of weight or change of bowel habits. She only reported that the last month she felt her lower tummy bloated. Due to absence of radiographer during this period in the hospital there was no possibility for any imaging investigations. Diagnostic laparoscopy revealed a phlegmon in the left abdomen consisting of the sigmoid colon, loops of the small bowel and wrapped by the omentum. Hartmann procedure was performed. Patient recovered uneventfully and was scheduled for reversal procedure. Surgical intervention is the treatment of choice for complicated large diverticular abscess; in the remote island, any delayed diagnosis may lead to life-threatening complications.