A 62-year-old man presents to the emergency department with a 2-day history of constant, worsening left lower quadrant abdominal pain. He also reports fever, mild nausea, and no bowel movements for the past 48 hours. His medical history is significant for hypertension and chronic constipation. His temperature is 38.6°C (101.5°F), blood pressure is 135/85 mm Hg, pulse is 92/min, and respirations are 16/min. Physical examination reveals focal tenderness to palpation in the left lower quadrant with voluntary guarding, but no rebound tenderness or diffuse rigidity. Laboratory studies show a leukocyte count of 14,000/mm³. Which of the following is the most appropriate next step in evaluation?
- Computed tomography scan of the abdomen and pelvisCevap
- BColonoscopy
- CExploratory laparotomy
- DBarium enema
- EAbdominal ultrasonography
Cevap
Computed tomography scan of the abdomen and pelvis
The patient's presentation of fever, left lower quadrant pain, and leukocytosis is highly suspicious for acute diverticulitis. In a hemodynamically stable patient without signs of generalized peritonitis, the most appropriate next step in evaluation is a computed tomography (CT) scan of the abdomen and pelvis. A CT scan can confirm the diagnosis by revealing colonic wall thickening and pericolic fat stranding, and it can also identify complications such as abscesses that might require percutaneous drainage or surgery.
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Anahtar Kavram
The diagnostic modality of choice for suspected acute diverticulitis in a hemodynamically stable patient without generalized peritonitis is a CT scan of the abdomen and pelvis with contrast.