08-24-2008, 12:03 PM
A 64-year-old man with a history of coronary artery disease (CAD) comes to the emergency department with the acute onset of severe, constant, Iower abdominal pain and rectal bleeding. He reports that he previously has had several episodes of similar, but less severe pain.
About 12 hours after the onset of pain, the patient began passing bright red blood per rectum. He denies nausea, vomiting, sick contacts, or foreign traveI. Rectal examination is positive for blood. Laboratory studies reveal a metabolic acidosis with an elevated serum Iactate.
Which of the following is the most likely diagnosis?
/ A. Colon carcinoma
/ B. Infectious colitis
/ C. Inflammatory bowel disease
/ D. Ischemic colitis
/ E. Necrotizing enterocolitis
About 12 hours after the onset of pain, the patient began passing bright red blood per rectum. He denies nausea, vomiting, sick contacts, or foreign traveI. Rectal examination is positive for blood. Laboratory studies reveal a metabolic acidosis with an elevated serum Iactate.
Which of the following is the most likely diagnosis?
/ A. Colon carcinoma
/ B. Infectious colitis
/ C. Inflammatory bowel disease
/ D. Ischemic colitis
/ E. Necrotizing enterocolitis