What should an older adult with abdominal pain, inflammatory response, low-grade fever, dry mouth, and urinary tract irritation, possibly with a history of diverticulitis, do?

Urgent Evaluation and Management Required

You need immediate medical evaluation, ideally in an emergency department, for CT imaging with IV contrast to confirm suspected diverticulitis and rule out complications, followed by appropriate antibiotic therapy if indicated. 1, 2

Immediate Diagnostic Approach

Your symptom constellation—abdominal pain, inflammatory response (low-grade fever), urinary tract irritation, and systemic symptoms (hot arms, odd smell, dry mouth)—strongly suggests acute diverticulitis, particularly given your possible history of this condition. However, clinical symptoms and laboratory tests alone are unreliable for diagnosis in older adults 2, 3, and complications can be missed without imaging.

Required Imaging

• CT scan of abdomen/pelvis with IV contrast is mandatory to confirm the diagnosis, distinguish uncomplicated from complicated diverticulitis, and exclude other serious conditions 1, 2
• The sensitivity is 98-99% and specificity is 99-100% for acute diverticulitis 4
• Do not assume the diagnosis without imaging, even with classic symptoms, as this is a critical pitfall in older adults 2
• If IV contrast is contraindicated due to severe kidney disease or contrast allergy, alternatives include ultrasound, MRI, or non-contrast CT 1, 2

Treatment Algorithm Based on CT Findings

If Uncomplicated Diverticulitis (No Abscess, Perforation, or Free Air)

For immunocompetent patients without high-risk features:

• Observation with supportive care is first-line: clear liquid diet and acetaminophen for pain 2, 4
• Antibiotics are NOT routinely necessary 1, 5

However, antibiotics ARE indicated if you have ANY of these features:

• Age >80 years 5, 4
• Persistent fever or chills 4
• Increasing white blood cell count 4
• C-reactive protein >140 mg/L 5
• Vomiting or inability to maintain hydration 5
• Immunocompromised status (steroids, chemotherapy, organ transplant) 5, 4
• Chronic medical conditions (cirrhosis, chronic kidney disease, heart failure, poorly controlled diabetes) 4
• Symptoms lasting >5 days 5

Recommended antibiotic regimen if indicated:

• Ciprofloxacin 500 mg orally twice daily PLUS metronidazole 500 mg orally three times daily for 4-7 days 5, 6
• Alternative: Amoxicillin-clavulanate 875/125 mg orally twice daily 5, 4

If Complicated Diverticulitis (Abscess, Free Air, or Peritonitis)

Immediate hospitalization is required 1, 2

• Start broad-spectrum IV antibiotics immediately: ceftriaxone plus metronidazole OR piperacillin-tazobactam 3, 4
• Abscess ≥4-5 cm requires percutaneous CT-guided drainage plus antibiotics 1, 3
• Free air or diffuse peritonitis requires emergency surgical consultation—non-operative management is contraindicated 1, 3

Critical Warning Signs Requiring Emergency Care

Go to the emergency department immediately if you experience:

• Fever above 101°F 5
• Severe or worsening abdominal pain 5
• Persistent nausea or vomiting 5
• Inability to eat or drink 5
• Signs of dehydration 5
• Confusion or altered mental status

Why Your Symptoms Suggest Diverticulitis

• Abdominal pain + low-grade fever + inflammatory response is the classic triad 4, 7
• Urinary tract irritation can occur when inflamed sigmoid colon is adjacent to the bladder 8
• Dry mouth suggests dehydration from decreased oral intake or fever 5
• Systemic symptoms (hot arms, odd smell) may indicate developing sepsis or systemic inflammatory response 3

Common Pitfalls to Avoid

• Never start antibiotics before confirming diagnosis and severity with imaging, as this represents unnecessary antibiotic exposure and may mask complications 2
• Do not delay seeking care thinking symptoms will resolve on their own—older adults are at higher risk for complications 1
• Do not assume you need antibiotics automatically—if imaging shows uncomplicated disease and you're immunocompetent, observation may be sufficient 1, 5

Follow-Up Requirements

• Re-evaluation within 7 days is mandatory, or sooner if symptoms worsen 1, 2
• Colonoscopy should be performed 6-8 weeks after symptom resolution to exclude malignancy 3, 4

The bottom line: Your symptoms warrant urgent medical evaluation with CT imaging today. Do not wait—complications like perforation or abscess formation can develop rapidly and carry significantly higher mortality if treatment is delayed. 1, 3