Alteration in normal bowel habits with constipation or diarrhea will occur. Abdominal exam reveals a tender mass and voluntary guarding in the lower abdomen. Rebound tenderness or referred rebound tenderness may be present. Pyrexia and tachycardia are usually present. Urinalysis can exclude urinary tract infection, fecaluria, and ureterolithiasis.
Leukocytosis is usually present.
The patient is best treated with hospitalization, bowel rest, IV hydration, and IV antibiotics. Antibiotics should cover both aerobes and anaerobes. Cefoxitin or Unasyn are good single agents to start with. If patients appear more toxic, then an aminoglycoside with metronidazole and ampicillin for enterococcus coverage may be used. Imipenem or Trovan may be used as a single agent in this situation.