An Unusual Presentation of Diverticulitis

Abstract

The patient is an 85-year-old male with a past medical history of hypertension, hyperlipidemia, benign prostatic hypertrophy, hemorrhoids (external and internal), chronic anal fissure, and diverticulosis who presents to the clinic with a two week historyof constant abdominal pain in his left lower quadrant along with intermittent bright red blood per rectum. He reports a rectal bleeding frequency of approximately 2-3 times a week. The abdominal pain is described to be dull and achy, not relieved by bowel movements, and not associated with movement or eating. The patient also reports feeling tired and his hemoglobin has been down trending from 12.7 two months ago to 11.5 today. The patient takes amlodipine 5mg and dutasteride 0.5 mg daily. His only surgical history is transurethral prostatic resection in 2002. He has a ten-pack year smoking history and has quit since 2019. The patient drinks 1 glass of alcohol about 1-2 times a week. His most recent colonoscopy was 08/2023 and was found to be negative for cancer and polyps. The patient denies any fever, nausea, vomiting, chills, night sweats, dizziness, change in diet, travel history, and recent antibiotic exposure. He reports unintentional 15-pound weight loss in the past year. Physical exam shows a soft, non-distended abdomen with no signs of peritonitis. The only positive finding on examination is pain in left lower quadrant with superficial and deep palpation.