A 68-year-old man presents to the emergency department with a 24-hour history of worsening abdominal pain, nausea, and vomiting. He has a history of open sigmoid colectomy for diverticulitis 10 years ago. On examination, his abdomen is distended and diffusely tender, with no palpable masses or hernias. He is afebrile, but his heart rate is 110 bpm despite a 2-liter bolus of IV fluids. Blood tests show a white cell count of 15 ×10⁹/L and lactate of 3.5 mmol/L. A CT abdomen and pelvis with contrast shows dilated loops of small bowel with a transition point in the mid-abdomen, no free air, and possible pneumatosis intestinalis (Gas in intestine walls).
What is the most appropriate next step in management?
More from Year 4
See allA a 68-year-old man with a history of gastroesophageal reflux disease presents with worsening kidney function over the past two weeks. He started a proton pump…
A 54-year-old man with no family history of prostate cancer attends his GP for a routine check-up. He is asymptomatic and has no significant past medical histor…
A 58-year-old man with no symptoms attends your clinic for a general health check. He is concerned because his uncle and cousin both died of pancreatic cancer.…
A 60-year-old man with a history of chronic diarrhea presents with muscle weakness and lethargy. Laboratory tests show: potassium 3.1 mmol/L (3.5-5.0 mmol/L), b…
A 50-year-old man presents to the emergency department with confusion, rapid breathing, and general weakness. He has a history of chronic kidney disease. On exa…