A 62-year-old patient presents to the emergency department with left lower quadrant abdominal pain, fever, and constipation. Which of the following is the BEST initial diagnostic test to confirm suspected diverticulitis?
Abdominal X-ray
CT scan of the abdomen and pelvis with contrast
Colonoscopy
Complete blood count (CBC)
The correct answer is a CT scan of the abdomen and pelvis with contrast. While all the listed options can be useful in evaluating a patient with suspected diverticulitis, a CT scan is considered the gold standard for diagnosis. It provides detailed images of the bowel wall and surrounding tissues, allowing for accurate identification of inflamed diverticula, abscesses, or other complications.
Although a complete blood count (CBC) can show elevated white blood cells, indicative of infection, it is not specific to diverticulitis. An abdominal X-ray may show nonspecific findings but lacks the sensitivity and specificity of a CT scan. A colonoscopy, while useful for diagnosing other colon conditions, is generally contraindicated in acute diverticulitis due to the risk of perforation.
It's important to note that the clinical presentation, along with the patient's age and symptoms, strongly suggests diverticulitis. The left lower quadrant pain is particularly characteristic of this condition, as diverticula most commonly occur in the sigmoid colon.
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