Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with acute onset of severe, diffuse abdominal pain, initially crampy and progressing to constant, localized peritonitis. Associated with hematochezia, urgency, and systemic signs of sepsis including tachycardia, hypotension, and altered mental status. History significant for [vascular disease/hypotension/atrial fibrillation].
Clinical Examination Findings
Abdominal exam reveals marked distension, diffuse tenderness, involuntary guarding, and rebound tenderness consistent with peritonitis. Bowel sounds are absent. Digital rectal exam confirms presence of bright red blood. Systemic assessment shows signs of shock: tachycardia, tachypnea, and peripheral hypoperfusion.
Treatment Protocol
Immediate resuscitation with aggressive IV fluid resuscitation, broad-spectrum antibiotics, and bowel rest (NPO). Emergent surgical consultation for exploratory laparotomy and resection of necrotic bowel segment. Hemodynamic monitoring in ICU; correction of underlying precipitating factors (e.g., vasopressor weaning, anticoagulation management).