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.
Nasogastric suction is unnecessary except for persistent emesis or obstruction.
A water-soluble contrast enema or CT scan is useful to confirm the diagnosis in atypical presentations or if not improving within 48 hours. Patients will complain of severe diffuse abdominal pain with anorexia, nausea and vomiting. The patient is tachycardic, pyrexic, and dehydrated. Severe tachycardia and hypotension are signs of septic shock. On examination, the patient will have a diffusely tender abdomen with involuntary guarding, rebound and percussion tenderness, and absent or rare bowel sounds.