Question of the week # 293

293) A 70 year old man is evaluated in the emergency room for abdominal pain , fever, nausea and vomiting that began 8 hours after he underwent a screening colonoscopy. The pain is severe and is mostly in the left lower quadrant of the abdomen. He reports that his colonoscopy procedure was uneventful except that he had a 2cm sessile polyp which was removed during the procedure. He denies any rectal bleeding. On examination, temperature is 102 F, blood pressure 100/60 mmHg, pulse 120, respiratory rate 28/min. Abdominal examination reveals severe tenderness,  guarding and rigidity in the left lower quadrant. Laboratory investigations show:

WBC 28k/µl with left shift

Hemoglobin 13.5 g/dL

Mean cell volume (MCV)  84  fL

Platelet count 310k/µl

Which of the following is most important next step in management?

A) Obtain urgent surgical consult

B) Rectal tube placement

C) Serum amylase level

D) Supportive care alone

E) Barium enema

10 Responses

  1. i think A is the answer besides urgent US and CT scaning of the abdomen

  2. Obtain urgent surgical consult

  3. A

  4. A

  5. A

  6. B……Although complications after colonoscopy are uncomon, it is importan to recognize early signs of any possible complications, including severe abdominal pain, fevers and chills or rectal bleeding. Bowel obstruction caused by electrolytes imbalances and dehydration could happen. Before surgical consult I will place a rectal tube.

    • since there is sign of peritonitis present, do laparotomy.

  7. A-

  8. A=could be perfirtion .

  9. There are signs of peritonitis- ho colonoscopy, fever , tenderness, rebound tenderness and guarding and leukocytosis. Surgical consult, CXR to check gas under diaphragm.
    Answer A

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