A 55-year-old woman presents with pain in the LLQ of the abdomen and fever of 102degF. On examination, she is found to be dehydrated and has tenderness in the LLQ. A CT scan shows a mass in the LLQ involving the sigmoid colon. There is a minimal amount of free fluid and no free air. What should the initial treatment of this patient include?

The findings described on physical examination and CT scan are suggestive of acute diverticulitis of the sigmoid colon. The initial treatment of this condition is expectant with antibiotics with or without nasogastric drainage. An antibiotic with specificity against the Bacteroides species (third-generation cephalosporin, metronidazole, or clindamycin) should be part of the regimen. Steroids have no place in the treatment. Laparotomy is indicated only after failure of conservative treatment.