03-12-2008, 08:30 AM
A 44-year-old previously healthy man is admitted to the hospital with a 3-day history of abdominal pain that initially started as a diffuse pain, and later became constant and severe, localized to the left lower quadrant. He also had nausea, vomiting, and a fever of 38.3 C (101.0 F). His past medical history is remarkable for an appendectomy at the age 9, and a hernia repair at the age of 20. Both surgical procedures were uneventful, and he was discharged home on the next postoperative day. On admission to the hospital, his temperature is 38.1 C (100.6 F), blood pressure is 140/80 mm Hg, and pulse is 90/min. Abdominal examination shows a distended, soft abdomen with tenderness and fullness in the left lower quadrant. Rectal examination does not reveal any abnormalities. A nasogastric tube is inserted and drains 400 ml bilious material. Laboratory studies show a leukocyte count of 18,000/mm3. Abdominal x-ray shows 6-7 air fluid levels with no free air. A CT scan of the abdomen and pelvis, performed on the day of admission to the hospital, confirms diverticulitis localized to the sigmoid colon with no abscess or free air. He is started on intravenous antibiotics and kept nil per os. Over the next few days, his temperature normalizes and his pain resolves with intravenous antibiotics. The most appropriate management of this patient is to
A. order a barium enema
B. perform a colonoscopy
C. recommend an elective sigmoid colon resection
D. repeat a CT scan of the abdomen and pelvis in 1-week
E. switch him to oral antibiotics
A. order a barium enema
B. perform a colonoscopy
C. recommend an elective sigmoid colon resection
D. repeat a CT scan of the abdomen and pelvis in 1-week
E. switch him to oral antibiotics