06-07-2008, 04:05 PM
A 66-year-old man is evaluated because of severe left lower quadrant pain. This morning he awoke with progressive lower abdominal pain. He described both a steady lower abdominal discomfort as well as waves of pain that came in œspasms.
Physical examination reveals a man in considerable abdominal distress. His temperature is 38.7 ºC (101.5 ºF), blood pressure is 160/88 mm Hg, and pulse rate is 108/min. He has occasional, high-pitched bowel sounds, and he is quite tender over the left lower quadrant. The remainder of the examination is normal. Laboratory abnormalities include a hemoglobin of 16 g/dL; leukocyte count of 12,600/μL with 15% band forms and 52% polymorphonuclear cells. A computed tomographic (CT) scan shows several air-filled loops of small intestine. There are multiple diverticula in the left colon, with thickening of wall and an inflammatory mass but no definite abscess.
Which of the following is the most appropriate management?
( A ) Laparotomy and colon resection
( B ) CT-guided biopsy of the inflammatory mass
( C ) Colonoscopy
( D ) Nasogastric suction and an antibiotic
Physical examination reveals a man in considerable abdominal distress. His temperature is 38.7 ºC (101.5 ºF), blood pressure is 160/88 mm Hg, and pulse rate is 108/min. He has occasional, high-pitched bowel sounds, and he is quite tender over the left lower quadrant. The remainder of the examination is normal. Laboratory abnormalities include a hemoglobin of 16 g/dL; leukocyte count of 12,600/μL with 15% band forms and 52% polymorphonuclear cells. A computed tomographic (CT) scan shows several air-filled loops of small intestine. There are multiple diverticula in the left colon, with thickening of wall and an inflammatory mass but no definite abscess.
Which of the following is the most appropriate management?
( A ) Laparotomy and colon resection
( B ) CT-guided biopsy of the inflammatory mass
( C ) Colonoscopy
( D ) Nasogastric suction and an antibiotic