Management of Acute Diverticulitis and Incidental Abdominal Aortic Aneurysm in a 67-Year-Old Male: A Case Report of Balancing Priorities in a High-Risk Patient

TL;DR

This case report describes the management of a 67-year-old man with both acute diverticulitis and a large abdominal aortic aneurysm, highlighting the challenges of treating multiple conditions in a high-risk patient.

Contribution

The paper presents a real-world example of balancing treatment priorities for coexisting diverticulitis and AAA in a high-risk patient.

Findings

Conservative treatment for diverticulitis followed by elective EVAR was effective for managing both conditions.

A type II endoleak was identified post-EVAR but managed successfully with blood pressure control and hydration.

The case emphasizes the importance of imaging and screening in high-risk populations to prevent life-threatening complications.

Abstract

Diverticular disease and abdominal aortic aneurysms (AAAs) represent distinct but significant clinical entities often associated with advanced age. Diverticulitis, a common complication of diverticular disease, can result in perforation and systemic complications, while AAAs, frequently asymptomatic, carry substantial morbidity and mortality risks if undetected or untreated. Advances in imaging have improved the early identification of these conditions, yet the simultaneous management of both presents unique challenges requiring multidisciplinary coordination.

A 67-year-old male with a history of ST-elevation myocardial infarction, hypertension, hyperlipidemia, and smoking presented with left lower quadrant abdominal pain and abnormal outpatient computed tomography (CT) findings. Imaging revealed Hinchey 1a diverticulitis with a microperforation and an incidental 6.5 cm saccular AAA. The patient received conservative treatment for diverticulitis with intravenous antibiotics and transitioned to oral antibiotics upon clinical improvement. Following resolution, the patient underwent successful endovascular aneurysm repair (EVAR) for the AAA, which was complicated by a type II endoleak identified postoperatively. Blood pressure management and hydration addressed acute kidney injury, and the patient recovered well with a multidisciplinary follow-up planned.

This case underscores the importance of imaging in diagnosing coexisting conditions, particularly in high-risk populations. Management required balancing the risks of treating acute diverticulitis with the need for prompt intervention for a large, saccular AAA. The conservative approach to diverticulitis, followed by elective EVAR, reflects a patient-centered strategy consistent with current guidelines. Furthermore, it underscores the critical role of adhering to screening recommendations for high-risk populations, as timely detection of asymptomatic conditions like AAAs can prevent life-threatening complications.

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