NMS. Casos Clínicos

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Part II ♦ Specific Disorders

Case 8.29 Left Lower Quadrant Pain and Fever A 70-year-old presents to the emergency department with abdominal pain and fever that developed several hours ago. History is unremarkable, except for occasional constipation. On physical examination, the patient has a fever of 101°F and mild tachycardia, with a BP of 140/85 mm Hg. The abdomen is tender in the left lower quadrant (LLQ). Q: What is the suspected diagnosis? A: Diverticulitis is likely in a patient with LLQ pain, tenderness, and fever. Occasionally, it is possible to palpate a mass in the LLQ. Q: What is the initial management? A: Because this patient is older and has a fever and tachycardia, more appropriate manage- ment may be complete bowel rest, IV hydration, and parenteral antibiotics . If nausea or vomiting develop, NG suction may be necessary. An abdominal obstructive series is warranted to check for free air and to search for other diagnoses. A clinician may choose to perform a CT scan to examine for inflammation, abscess, diverticula, and a thickened sigmoid bowel wall, which confirms a diagnosis of diverticulitis ( Fig. 8-32 ). However, CT is not mandatory in uncomplicated patients. Another concern is that the symptoms are from a perforated colon cancer ; signs and symptoms may be similar. The management plan should include careful, serial abdominal examinations to check for progression of the disease. Generally, patients with minimal

Figure 8-32: CT scan of diverticulitis, showing “fat stranding” and edema of the tissue near the inflamed colon. SAMPLE