What is the diagnosis and treatment for a 76-year-old female with abdominal pain, given CT scan findings of colonic enteritis, ileus pattern, obstipation, diverticulosis coli, and evidence of hardware failure and sacral fracture?

Management of Abdominal Pain in a 76-Year-Old Female with CT Findings

Based on your CT findings, you have diverticulosis with signs of colonic obstipation and possible ileus, which requires prompt medical management to prevent complications and improve your quality of life.

Explanation of CT Findings

Your CT scan shows several findings that explain your abdominal pain:

1. Obstipation of the colon: This means severe constipation with hardened stool that's difficult to pass
2. Colonic enteritis/ileus pattern: Your colon shows signs of inflammation and decreased movement
3. Mobile cecum in the lower pelvis: Your cecum (first part of the large intestine) is not in its normal position
4. Diverticulosis coli: You have multiple small pouches (diverticula) in your colon wall
5. Hardware failure and sacral fracture: The metal fixation in your lower spine shows signs of failure

Treatment Recommendations

Immediate Management

1. Bowel Rest and Hydration

   • Clear liquids only for 24-48 hours
   • Gradually advance to low-fiber diet as symptoms improve
   • Increase fluid intake to 2-3 liters daily unless contraindicated

2. Medication Therapy

   • Broad-spectrum antibiotics for 5-7 days as you have signs of colonic inflammation 1, 2
   • Options include:
     • Amoxicillin-clavulanate 875/125 mg orally twice daily
     • Alternative: Ciprofloxacin 500 mg plus Metronidazole 500 mg twice daily

3. Surgical Consultation

   • Recommended due to your mobile cecum finding 1
   • This abnormal positioning can potentially lead to cecal volvulus (twisting)

Follow-up Care

1. Imaging Follow-up

   • Repeat CT scan in 4-6 weeks to assess resolution of inflammation

2. Colonoscopy

   • Schedule 6-8 weeks after resolution of acute symptoms
   • Essential to rule out malignancy and assess diverticular disease 1, 2

3. Orthopedic Consultation

   • Evaluation of hardware failure and sacral fracture
   • This may be contributing to your pain and mobility issues

What to Expect

• Symptoms should begin improving within 48-72 hours of starting treatment
• If symptoms worsen (increased pain, fever, vomiting), seek immediate medical attention
• Complete resolution typically takes 1-2 weeks with appropriate treatment

Warning Signs to Watch For

• Fever above 101°F
• Severe, worsening abdominal pain
• Inability to pass gas or stool
• Persistent vomiting
• These may indicate progression to complicated diverticulitis requiring hospitalization 2

Long-term Management

• High-fiber diet (25-30g daily) once acute episode resolves
• Regular physical activity as tolerated
• Maintain adequate hydration
• Regular follow-up with your physician

Important Considerations

• Your age puts you at higher risk for complications from diverticulitis 1
• The combination of spinal hardware failure and abdominal issues requires coordinated care between specialists
• Approximately 5% of uncomplicated cases can progress to complicated diverticulitis requiring more aggressive intervention 2