A 78-year-old with atrial fibrillation has sudden severe abdominal pain but minimal tenderness. Lactate is 1.4 mmol/L and routine contrast CT has not

Question

A 78-year-old with atrial fibrillation has sudden severe abdominal pain but minimal tenderness. Lactate is 1.4 mmol/L and routine contrast CT has not been performed. What is the best diagnostic test?

Accepted Answer

Obtain urgent CT angiography of the mesenteric circulation

Answer

Perform noncontrast abdominal CT to identify early bowel-wall ischemia

Answer

Obtain duplex ultrasonography as the definitive acute arterial study

Answer

Use the normal lactate to select serial examinations and repeat bloodwork

Answer

Proceed to colonoscopy to assess mucosal perfusion and embolic injury

Complicated appendicitis — RCPSC EM MCQ

A 78-year-old with atrial fibrillation has sudden severe abdominal pain but minimal tenderness. Lactate is 1.4 mmol/L and routine contrast CT has not been performed. What is the best diagnostic test?