Intraabdominal infection and acute abdomen

A 57-year-old man presents to the emergency department complaining of severe, cramping abdominal pain that has significantly worsened in the past 7 hours. The pain has been continuous and gradually worsening since its onset over the past 72 hours. The pain is localized to the left lower quadrant and is associated with nausea and vomiting. He felt feverish but did not take his temperature.

He reports a history of hypertension and hypercholesterolemia, but denies any significant gastrointestinal problems prior to this episode, except some slight constipation and occasional dyspepsia after heavy meals.

His family history is negative for gastrointestinal disorders, and he denies any trauma.

What will be your diagnostic approach?

Help

Obtain intravenous access. Order imaging (CT with contrast) and monitor the patient’s vital signs and course while waiting for new developments.

Obtain intravenous access, then order imaging (ultrasound, plain abdominal/chest x-rays) and routine laboratory testing (CBC, CRP, urinalysis, serum electrolytes). While awaiting results, call for a surgical consult, as operative management may be needed.

Perform a digital rectal examination, obtain intravenous access, and order routine laboratory testing (CBC, CRP, urinalysis, serum electrolytes). The patient should also be prepped for colonoscopy for colonic evaluation. Any visualized lesions should be subsequently biopsied to obtain histological confirmation.

Obtain intravenous access and order routine laboratory testing (CBC, CRP, urinalysis, serum electrolytes). While awaiting results, call for a surgical consult and ask the patient about the time of his last meal. The patient should undergo a laparoscopic revision to examine the abdominal organs so that the spectrum of differential diagnoses can be narrowed.

years

man

15 /min

108 /min

SpO2

98 %

146/92 (110) mmHg

temperature

38 °C

GCS

Examination

Patient is alert. On examination, he is in obvious pain, lying still, tachycardia. His abdominal exam shows absent bowel sounds, diffuse tenderness, rigidity on palpation, and pain on percussion.