CASE
A 66-year-old white female presented with complaints of abdominal pain and a 2-week history of a change in bowel habits. The pain was throbbing in nature and did not radiate. It was located bilaterally in the lower abdomen and was partially relieved by OTC analgesics. The patient reported the pain was originally a 9 in severity but was currently a 5. The onset of severe constipation coincided with the onset of abdominal pain. After using an enema, she experienced frequent episodes of diarrhea and one episode of bright red blood from the rectum on toilet paper. She reported having had two normal bowel movements that morning. Fevers were recorded by the patient ranging from 101°F to 102°F orally for the past 2 days, as well as a 5-lb weight loss over the past 2 weeks.
History The patient had a history of irritable bowel syndrome and diverticulosis. She reported that her grandchildren, for whom she is a caretaker, had gastroenteritis when her symptoms began. Her last colonoscopy, performed 2½ years ago, revealed left-sided diverticulosis and internal hemorrhoids. The patient's mother died from colon cancer at age 76 years. Her surgical history included an appendectomy and hysterectomy. She denied recent travel and did not take any prescription medications.
Physical examination The patient was afebrile and normotensive. Her abdomen was nondistended with active bowel sounds and without bruits. The ab domen was tympanic, and hepato splenomegaly was not appreciated. Pain was noted on light and deep palpation of the right and left lower quadrants. Tenderness was significantly greater in the left lower quadrant than in the right. There was guarding but no rigidity, referred pain, or rebound tenderness. She refused the rectal examination.
Diagnostic test results Laboratory tests results were WBC count, 20,500/ μL; neutrophils, 78%; lymphocytes, 15%; hemoglobin, 12 g/dL; hematocrit, 36.1%; platelets, 604 103/μL; ESR, 89 mm/h; C-reactive protein, 26.5 mg/L. Stool studies were ordered. CT of the abdomen (Figure 1) and pelvis was obtained with oral contrast because a BUN and creatinine level were not available.
Click NEXT to find the true diagnosis.