A 67-year-old male presents to the emergency department with left lower quadrant pain and fever for 1 day.
Laboratory results show:
WBC 14.8 cells/mm3
Hb 12.0 g/dL
Hct 38%
Na 138 mEq/L
K 4.0 mEq/L
Creatinine 1.0 mg/dL
Which of the following studies is contraindicated in the workup of this patient?
1.MRI
2.Ultrasound
3.Contrast CT
4.Colonoscopy
5.Abdominal radiograph
explanation
This patient’s presentation is consistent with acute diverticulitis. Colonoscopy is contraindicated in acute diverticulitis due to the risk of bowel perforation. CT is the preferred diagnostic modality.
Acute diverticulitis typically presents with constipation or diarrhea along with LLQ tenderness. Age and low-fiber diet are the most important risk factors. CT is the preferred diagnostic imaging in suspected acute diverticulitis.
Illustration A is a CT with oral and IV contrast showing diverticulitis. The arrows demonstrate wall thickening in the sigmoid colon with adjacent inflammatory changes in the pericolic fat.