What is the first step in investigating acutely unwell surgical patients suspected of diverticulitis?

The initial step in investigating acutely unwell surgical patients suspected of diverticulitis often involves obtaining a chest X-ray (CXR) and an abdominal X-ray (AXR). This approach allows for a rapid assessment of the patient's overall condition and can help identify any immediate complications such as free air indicating perforation or other significant abnormalities in the abdominal cavity.

A chest X-ray can provide insight into potential respiratory issues or complications, while an abdominal X-ray can help visualize distension, free air, or other signs of bowel obstruction. These imaging techniques are non-invasive and readily available, enabling quick evaluation in an acute setting, particularly when a patient presents with abdominal pain and systemic symptoms.

While a CT scan of the abdomen is indeed the gold standard for diagnosing diverticulitis and providing detailed information about the condition, it is generally reserved for cases where the diagnosis is uncertain after initial imaging. Ultrasound may also be useful in certain situations, particularly in specific populations, but it is not typically the first-line investigation for diverticulitis in acutely unwell patients, as it is operator-dependent and less comprehensive for this particular condition. MRI is less commonly used due to cost and availability, and it is generally reserved for specific indications, such as in pregnant patients.