A 72-year-old man is evaluated because of constipation, abdominal pain, and distention that have worsened over the past week. Two years ago, he was diagnosed with stage III rectal cancer (primary tumor and renal involvement) and underwent low anterior resection. Chemotherapy with 5-fluorouracil and leucovorin followed, and pelvic radiation was given with concurrent infusion of 5-fluorouracil. He has been having regular bowel movements, and results of his most recent colonoscopy (1 year ago) were unremarkable. On physical examination, his pulse rate is 100/min. He has orthostatic hypotension, a slightly distended abdomen with hyperactive bowel sounds, and some guarding to deep palpation in the left lower quadrant. Plain radiograph of the abdomen shows distended loops of small bowel, with no stool in the distal colon or rectum. The patient is hospitalized for bowel rest and intravenous hydration. What is the next step in this patient"s management?

Question

Quizplus · Accepted Answer

Given the patient's history of rectal cancer, worsening abdominal symptoms, and radiographic evidence of small bowel obstruction, a CT scan of the abdomen with oral and intravenous contrast is the most appropriate next step to evaluate for possible cancer recurrence or metastasis, as well as to identify the cause and location of the obstruction.

A 72-Year-Old Man Is Evaluated Because of Constipation, Abdominal Pain