An elderly patient with left lower quadrant pain and fever is more likely to have which diagnosis?

• A. Ischemic colitis
• B. Diverticulitis
• C. Appendicitis
• D. Crohn disease

Answer: (D)

Diverticulitis is most likely in an older adult who has left lower quadrant abdominal pain with fever because this combination points to inflammation of colonic diverticula, which are most common in the sigmoid colon. As people age, diverticulosis becomes common, and when a diverticulum becomes infected or inflamed, pain localizes to the left lower quadrant with fever and often leukocytosis. The other conditions don’t fit as well: appendicitis typically causes right lower quadrant pain; Crohn disease can cause abdominal pain but new-onset Crohn in the elderly is less common and usually has a broader, more chronic course; ischemic colitis can occur in the elderly and cause LLQ pain with fever, but it often presents with abrupt onset and a history of vascular disease and may have bloody stools. Thus, diverticulitis best explains LLQ pain with fever in an elderly patient, and that’s the most likely diagnosis.