Gastroenterology
Case 20: A Patient with Lower Abdominal Pain, Diarrhoea and Weight Loss
CASE
An 84‐year‐old man is referred with a month's history of lower abdominal pain, diarrhoea and weight loss. His appetite has been poor and he has lost a stone in weight. More latterly he has developed fever and dysuria. Prior to this time he has been well. He had a transureathral resection for benign prostatic hypertrophy 2 years before. He had had a barium enema performed 10 years earlier for symptomatic constipation. This had shown diverticular change only.
On examination he looks unwell with a fever of 38.4°C and a tachycardia. He looks dry although he is peripherally vasodilated with a bounding pulse and low blood pressure. Abdominal examination demonstrates a large tender mass in the left iliac fossa. This mass is dull to percussion and hot to the touch.
Blood tests showed:
Hb 11.8 g/dL WCC 14.5 × 109/L Platelets 305 × 109/L Na 140 mmol/L K 4.2 mmol/L Urea 8.7 mmol/L Creatinine 120 µmol/L Urine dipstick protein ++, blood +, nitrites ++
Plain abdominal film shows an unremarkable gas pattern. There is no evidence of pnemoperitoneum.
QUESTION 1
Your score this session: 0 of 0
This mass would be best investigated by: