A 60-Year-Old Man With Intense Left-Sided Abdominal Pain

Pramod Gupta, MD; Jitendra Gohil, MD


October 12, 2016

Physical Examination and Workup

Figure 1

Figure 2

Figure 3

On physical examination, the patient has an elevated temperature of 101.3°F, blood pressure of 130/76 mm Hg, pulse of 110 beats/min, and respiratory rate of 20 breaths/min. The patient is not in acute distress, but he is mildly ill-appearing and diaphoretic. His oropharynx is clear, with slightly dry mucous membranes. His lungs are clear to auscultation, and his heart rate is regular, without murmurs.

The abdominal examination reveals moderate tenderness in the left lower quadrant, with voluntary guarding. No rebound tenderness is noted. No costovertebral angle tenderness or inguinal hernias are appreciated, and his genital examination findings are normal. Upon digital rectal examination, the patient is tender on the left side of the rectal vault, and the stool is noted to guaiac-negative. The remainder of the physical examination findings are unremarkable.

Serum laboratory testing is remarkable only for an elevated white blood cell count of 16 × 103 cells/µL, with a neutrophil predominance; the urinalysis is unremarkable. A standard radiograph of the abdomen is obtained, which does not show any significant abnormalities (Figure 1). The patient then underwent CT of the abdomen and pelvis (Figures 2 and 3).


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