A 54-year-old man comes to the office for follow-up after a recent colonoscopy. Six weeks ago, the patient was hospitalized due to left lower quadrant abdominal pain; CT scan of the abdomen revealed focal thickening of the sigmoid wall. The symptoms resolved with treatment and the patient underwent outpatient colonoscopy a week ago, which revealed sigmoid colon findings as shown in the exhibit. The patient now feels well and reports no residual symptoms. Physical examination is normal. Which of the following is the most appropriate recommendation to prevent future complications from this patient's condition?

Question

A 54-year-old man comes to the office for follow-up after a recent colonoscopy.  Six weeks ago, the patient was hospitalized due to left lower quadrant abdominal pain; CT scan of the abdomen revealed focal thickening of the sigmoid wall.  The symptoms resolved with treatment and the patient underwent outpatient colonoscopy a week ago, which revealed sigmoid colon findings as shown in the exhibit.  The patient now feels well and reports no residual symptoms.  Physical examination is normal.  Which of the following is the most appropriate recommendation to prevent future complications from this patient's condition?

Quizplus · Accepted Answer

11ec25c8_d3e5_4f21_bc81_dda57264907c_MD0003_00 Diverticula are outpouchings of the colonic wall that form at points of weakness, most commonly in the sigmoid colon. Diverticulosis is a common finding on endoscopy, and the incidence increases with age. Although diverticulosis is usually asymptomatic, potential complications include diverticular bleeding (due to injury to the colonic vasculature) or diverticulitis. Diverticula Acute diverticulitis occurs due to inflammation associated with microperforation of a diverticulum; it typically presents with left lower quadrant pain, nausea/vomiting, and fever. CT findings include focal thickening of the colon wall and pericolonic fat stranding; diverticula are not always seen. Initial management includes antibiotics (eg, ciprofloxacin plus metronidazole) and bowel rest. Because colonic malignancy may mimic the presentation and CT findings seen in diverticulitis, follow up colonoscopy (typically 4-8 weeks later) is often recommended to rule out malignancy and evaluate the extent of diverticulosis. Diverticular diseases are strongly associated with chronic constipation; the increased colonic pressures in constipation may promote formation of diverticula, and conversely, the altered motility seen in diverticulosis may contribute to constipation. Diets high in fruit and vegetable fiber help prevent further complications of diverticulosis by softening the stool and preventing constipation. Physical activity is also inversely correlated with the risk of complications. Factors associated with an increased risk include heavy meat consumption, obesity, and smoking. (Choice A) In the past, patients with diverticulosis were advised to avoid nuts and seeds under the assumption that these hard objects may obstruct the diverticular lumen and precipitate acute diverticulitis. However, recent studies have found no link between intake of these foods and incidence of diverticulitis. (Choice B) Daily low-dose aspirin is associated with a lower risk of colorectal cancer. However, frequent use of aspirin and nonsteroidal anti-inflammatory drugs is associated with a higher risk of diverticular complications. (Choice C) Surgery is indicated for diverticulosis complicated by recurrent bleeding, perforation, peritonitis, or abscess that does not resolve with percutaneous drainage. Uncomplicated diverticulosis can otherwise be managed nonoperatively. (Choice D) Frequent colonoscopy is indicated for patients at increased risk for colon cancer (eg, large or multiple adenomatous polyps, Lynch syndrome). In the absence of adenomas, patients with diverticulosis may return to a routine colon screening schedule. (Choice F) Probiotic therapy is sometimes used for acute infectious diarrhea and functional gastrointestinal disorders. However, it has not demonstrated benefit in prevention of diverticular complications. Educational objective: Diverticulosis is associated with chronic constipation. It is usually asymptomatic, but potential complications include hemorrhage and diverticulitis. The risk of complications is lower with increased intake of fruit and vegetable fiber; it is higher with heavy meat consumption, aspirin or nonsteroidal anti-inflammatory drug use, obesity, and smoking. References: Diverticulosis and diverticulitis. (http://www.ncbi.nlm.nih.gov/pubmed/27156370) Colonic diverticular disease. (http://www.ncbi.nlm.nih.gov/pubmed/21401970)

A 54-Year-Old Man Comes to the Office for Follow-Up After