Which factor is most indicative of the need for surgical intervention in diverticulitis?

The presence of an abscess or perforation is the most indicative factor for surgical intervention in diverticulitis. When diverticulitis occurs, it can lead to complications such as the formation of an abscess or the perforation of the diverticula within the colon. An abscess indicates localized infection and potential complications with the surrounding structures, while perforation poses an immediate risk of peritonitis, which is a surgical emergency.

Surgical intervention is often necessary to manage these complications effectively. In cases of perforation, the contents of the bowel can leak into the abdominal cavity, leading to severe inflammation and infection that require urgent surgical repair and possibly resection of the affected segment of the colon.

The other factors listed, such as severe abdominal pain, low-grade fever, and a high white blood cell count, may indicate the presence of diverticulitis or the severity of the inflammatory process but are not definitive indicators for the necessity of surgery. They can sometimes be managed conservatively with antibiotics and dietary modifications unless more severe complications arise, such as abscess or perforation.