A 72-year-old man presents with a 2-day history of fever, left iliac fossa pain, and absolute constipation. He has a known history of diverticular disease.
On examination, there is localized tenderness and guarding in the left iliac fossa. There is no generalized peritonism.
HR 98 bpm, BP 128/82 mmHg, Temp 38.4°C, RR 18/min, SpO₂ 97% on room air, GCS 15/15.
Bloods:
- White cell count 16.2 x 10⁹/L
- CRP 185 mg/L
CT abdomen/pelvis: Sigmoid colon wall thickening with pericolic fat stranding. There is a 5cm localized pelvic fluid collection (Modified Hinchey Grade II). There is no free intraperitoneal air.
What is the MOST appropriate management?
Admit for IV antibiotics and clinical observation
Admit for an emergency open Hartmann's procedure
Admit for IV antibiotics and CT-guided drainage
Admit for laparoscopic washout and pelvic drainage
Admit for an urgent inpatient sigmoid colectomy