Question

An 80-year-old man with a history of divertulosis and multiple episodes of diverticulitis presents to the emergency room for increasing crampy abdominal pain, nausea, and vomiting. He last had a bowel movement 4 days ago and has had tiny amounts of diarrhea. He has not had any flatus since last night. On physical exam, his abdomen is noted to be distended, somewhat rigid, and tender to palpation. Bowel sounds are absent. A digital rectal exam reveals hard stool in the rectal vault. An abdominal radiograph shows dilated loops of bowel but no free air under the diagphragm. A computed tomography of his abdomen and pelvis confirms the presence of dilated loops of bowel and a large fecolith. What is the diagnosis?

Answer 1

The elderly patient's symptoms and imaging findings suggest an acute episode of diverticulitis with a complication, likely an intestinal obstruction due to a fecolith.

Step-by-step explanation:

The diagnosis for the 80-year-old man with a history of diverticulosis and episodes of diverticulitis, presenting with crampy abdominal pain, nausea, vomiting, lack of bowel movements, and no flatus is likely an acute episode of diverticulitis with a complication, possibly an intestinal obstruction due to a large fecolith.Diverticulitis is a condition where pouches in the colon called diverticula become infected and inflamed.

The presence of a fecolith (a hardened stool that can block the bowel) indicates a possible obstruction which is supported by the symptoms of abdominal distension, rigidity, and absence of bowel sounds, as well as the imaging findings on the abdominal radiograph and CT scan. The lack of free air under the diaphragm rules out perforation. Management typically requires hospitalization, possible intravenous antibiotics, and complete bowel rest, with surgery as an option for complications such as abscess or severe obstruction.