The most appropriate management for this woman with diverticulitis is treatment with oral antibiotics with home discharge and close clinical follow-up. The therapeutic approach to diverticulitis is dictated by patient-related factors, the severity of clinical features, and the ability to tolerate oral intake. In a healthy, immunocompetent patient with mild symptoms, outpatient therapy is appropriate and should consist of a liquid diet, oral antimicrobial agents that cover colonic organisms and include anaerobic coverage (such as ciprofloxacin and metronidazole), and as-needed analgesia. Close follow-up is warranted to detect any deterioration as soon as possible. For older, frail, sicker patients, and in those with potential complications of diverticulitis (such as peritonitis or fistula formation), hospitalization is recommended for administration of intravenous antimicrobial agents and observation. This patient with diverticulitis has mild symptoms and is otherwise healthy. She is able to maintain oral intake and can therefore be managed as an outpatient with oral antibiotics and close follow-up.

Surgery is pursued acutely only in patients who have free perforation or peritonitis, or in those for whom medical therapy is unsuccessful. If indicated, both laparoscopic and open procedures are options; laparoscopic treatment is associated with a more rapid recovery time. This patient does not have a current indication for surgical intervention.

Percutaneous drainage is typically indicated in patients with diverticulitis with larger abscesses (often considered to be >3 cm) that are procedurally amenable in those without evidence of peritonitis. Smaller abscesses are usually treated with antibiotics alone and close follow-up. This patient does not have evidence of an abscess on imaging; therefore, percutaneous drainage is not indicated.

Colonoscopy is recommended after recovery because diverticulitis may be precipitated by a sigmoid cancer; however, colonoscopy during an attack is contraindicated because it would be very difficult to insert the colonoscope beyond the area of inflammation and obtain adequate mucosal inspection. In addition, it may cause peritonitis.