Case #22
Do No Harm — Watch the Beans.
A 62 y/o male presents with LLL abdominal
pain. The pain came on gradually, located in
the LLQ, and is described as ‘achey.’ There
has been some nausea, and today the patient
vomited twice. He also felt feverish, but
did not take his temperature.
ROS: No HEENT complaints, no chest pain,
SOB, cough. He has been nauseous, vomited
twice, no hemetemesis, no coffee ground
emesis. He did get diaphoretic when he
vomited. His bowel movements tend to be
hard, and he has not had a BM in 2 days,
which is normal for him (he has 2-3
BM/week). No urinary complaints. No rashes.
No new neurologic complaints.
PMH: Hypertension and NIDDM. No
surgeries.
Meds: Lopressor and Glucophage
SH: No smoking/ ETOH
FH non-contributory
PE: WDWN male, Obese, in no acute
distress
VS: BP 145/85, P=70, RR=18, T=100.3
HEENT: Unremarkable except dry mucus
membranes
Heart: RRR no murmurs
Lungs: Clear bilaterally
Abd: Obese, tender in LLQ without rebound.
Bowel sounds decreased. No guarding. No
masses palpated. Rectal: enlarged prostate,
trace guiac positive stools (hemacult
positive).
You order acute abdominal series, and
routine abdominal labs, and ECG. You also
initiate IV hydration with bolus of 500 cc
Normal Saline, then 150 cc/hr.
Pertinent findings:
WBC-15K, 90% Neutrophils, no bands
Glucose – 257
Bun = 22
Creatinine = 1.4
All other labs normal.
Acute abdominal series reveals an ileus
in the LLQ.
You admit the patient to the patient's
primary care service with the diagnosis of
ileus, probable diverticulitis, R/O abscess.
A surgical consult is ordered along with an
abdominal CT, and antibiotics are started.
1. What do you need to worry about?
2. What do you need to tell the patient?
3. What can you do to limit harm to this
patient?
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