SHM Converge Scientific Abstract ePoster Gallery-The Many Faces of Acute Abdomen

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This case describes a 93-year-old woman who presented to the emergency department with multiple episodes of watery diarrhea, decreased appetite, confusion, and drowsiness. On arrival, she was intubated for airway protection. Exam revealed diffuse lower abdominal tenderness. She was also profoundly bradycardic with soft blood pressures. Laboratory studies showed marked leukocytosis, severe hyperkalemia, lactic acidosis, metabolic acidosis, and acute kidney injury. CT imaging of the abdomen and pelvis demonstrated scattered small bowel diverticula with diverticulitis complicated by perforation and small amounts of free intraperitoneal air, along with pancolonic diverticulosis.<br /><br />Her hyperkalemia-related complete heart block and acute kidney injury improved with medical treatment. She was started on broad-spectrum antibiotics, placed on bowel rest, and evaluated by surgery. Because she remained clinically stable and serial CT scans showed improvement with resolved free air, the perforation was managed conservatively rather than operatively. Over time, her abdominal tenderness resolved, bowel function returned, and renal function improved. Her hospital course was later complicated by ESBL pneumonia, requiring a change in antibiotics to meropenem. She was eventually weaned off the ventilator and discharged home on ertapenem with follow-up arranged with Infectious Disease and General Surgery.<br /><br />The discussion emphasizes that non-Meckel small bowel diverticulosis is rare, occurring in about 1% of the population, and is often asymptomatic. When symptomatic, it may present with nonspecific complaints such as diarrhea, chronic abdominal pain, bloating, or malabsorption. Serious complications like diverticulitis, perforation, abscess, obstruction, fistula, and bleeding are uncommon but potentially severe. This case highlights small bowel diverticulitis as an important, though rare, cause of acute abdomen in older adults, and shows that selected stable patients with localized perforation may be successfully treated with antibiotics and close monitoring.

Asset Subtitle

Tissa Bijoy George

Meta Tag

Author List Anjana Chandrasekhara Pillai, Collins Chibuzo Njoku, Meghan Fitzpatrick, Tissa Bijoy George

Category Clinical Vignettes

Concept Small Bowel Diverticulosis

Concept Small Bowel Diverticulitis

Concept Acute Abdominal Symptoms

Concept Perforation

Concept Observation

Distinguished Non-Finalist

Presenter Organization Upmc

Presenting Author Tissa Bijoy George

Track Adult

Keywords

small bowel diverticulitis

perforation

pneumoperitoneum

hyperkalemia

complete heart block

acute kidney injury

elderly patient

conservative management

broad-spectrum antibiotics

abdominal pain

Small Bowel Diverticulosis

Small Bowel Diverticulitis

Acute Abdominal Symptoms

Perforation

Observation