Question

A 60-year-old man presents to the emergency department with abdominal and flank pain on the left side. He states that it started 2 days ago and has been worsening. The patient has a past medical history of diabetes and hypertension and recently completed a course of oral antibiotics for diverticulitis. His temperature is 101°F (38.3°C), blood pressure is 161/97 mmHg, pulse is 107/min, respirations are 15/min, and oxygen saturation is 99% on room air. Physical exam does not reveal any abdominal or costovertebral angle tenderness. Flexion of the left leg against resistance elicits pain as does extension of the left hip. Which of the following is the most appropriate next step in management?

a. Colonoscopy
b. CT scan of the abdomen and pelvis
c. Kidneys, ureters, and bladder radiograph
d. Ultrasound
e. Urinalysis

Answer 1

A CT scan of the abdomen and pelvis is the most appropriate next step for diagnosing potential complications of diverticulitis in a patient presenting with symptoms consistent with this condition.

Step-by-step explanation:

The most appropriate next step in management for a 60-year-old man with a history of diverticulitis presenting with left-sided abdominal and flank pain, fever, and difficulty with certain movements is a CT scan of the abdomen and pelvis. This imaging study is specifically helpful to diagnose or rule out complications of diverticulitis, such as an abscess or perforation, which could be suggested by the patient's history of diverticulitis and current presentation.

Given the lack of abdominal or costovertebral angle tenderness on the physical exam and pain elicited by hip movement, other causes of abdominal pain have been considered. These could potentially include musculoskeletal issues or another intra-abdominal process such as an abscess that may not be immediately apparent upon physical examination.

A colonoscopy would ordinarily not be performed in the acute setting due to the risk of perforation, especially in a patient who could potentially have acute diverticulitis. Other options such as a kidneys, ureters, and bladder (KUB) radiograph, ultrasound, or urinalysis may not provide enough detailed information to diagnose or rule out conditions like abscess formation or other complications arising from diverticulitis.