A 55-year-old man presents with left lower quadrant (LLQ) abdominal pain of 2-day duration, associated with constipation. On physical examination, he has tenderness localized to the LLQ with fullness in that area leukocyte count is 22,000 and temperature is 101.5degF. Which would be the best diagnostic study to evaluate this man?
Correct Answer: Computed tomography (CT) of the abdomen/pelvis with orally (PO) and intravenous (IV) contrast
Description: The man likely has diverticulitis. The differential includes irritable bowel, appendicitis, inflammatory bowel disease, pyelonephritis, ischemic colitis, and perforated carcinoma. Diverticulitis is an infectious complication of diverticulosis resulting from perforation of the colonic diverticulum. The resulting inflammation may be confined to the peri colonic tissue (uncomplicated diverticulitis) or result in abscess, free perforation, fistulization, or obstruction (complicated diverticulitis). The clinical spectrum is correspondingly broad ranging from mild symptoms to peritonitis and sepsis. Patients with signs and symptoms of sepsis should be hospitalized and undergo diagnostic study. A CT scan is the best study to evaluate the extent of the inflammatory process as well as to exclude other pathology. Plain x-ray would not reveal specific pathology. Both barium enema and colonoscopy in the acute setting are risky and may cause free perforation and contamination of the peritoneal cavity there by converting a localized process to generalized peritonitis. Barium has the additional risk of a chemical peritonitis caused by the barium itself. Diagnostic laparoscopy is invasive and may risk spreading a localized process.
Category:
Surgery
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