. A 32-year-old man with a history of Crohn’s disease presents to the ED with acute-onset dif fuse abdominal pain and emesis. The patient states that these symptoms are different than his usual Crohn’s disease flare-ups. The pain is severe (10/10) and is cramping in nature. The patient states that his abdomen feels larger than usual. His Crohn’s disease has been well managed on 6-mercaptopurine for the past 6 months. The patient denies any recent sick contacts or eating underprepared foods. He states that he has had a bowel movement and flatus since the abdominal pain began. In addi tion to Crohn’s disease, the patient has a past medical history significant for appendicitis for which he underwent an appendectomy 12 years ago. His temperature is 37.1°C (98.7°F), blood pressure is 135/86 mm Hg, pulse is 84/min, and respiratory rate is 14/min. On physical examination, the abdomen is dis tended and diffusely tender with high-pitched bowel sounds. There is rebound tenderness throughout the abdomen along with guarding. The remainder of the physical examination is noncontributory. An x-ray of the abdomen was obtained in which dilated small loops of bowel were noted along with absence of gas in the colon. What is the next step in the manage ment of this patient? (A) Bowel rest only (B) Intravenous fluids and antibiotics only (C) Laparotomy (D) MRI of the abdomen (E) Ultrasound
Posted on: Wed, 31 Dec 2014 22:04:40 +0000
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