A 25-year-old woman with known ulcerative colitis presents to the emergency room with a 24-hour history of abdominal pain, distention, and obstipation. Physical examination reveals a temperature of 38.6° C, abdominal distention, and diffuse abdominal tenderness. Abdominal x-rays show marked colonic dilatation, most pronounced in the transverse colon. Laboratory examination reveals a white blood count of 19,000/mm3. Over the first 24 hours of hospitalization, symptoms are progressive in spite of intravenous fluid resuscitation, nasogastric suctioning, and intravenous antibiotics. The most appropriate management for this patient would include which of the following?
A. Decompressive colonoscopy
B. Proctocolectomy with formation of end ileostomy
C. Total abdominal colectomy with formation of Hartmann pouch and end ileostomy
D. Cecostomy
Answer:C
A 25-year-old woman with known ulcerative colitis presents to the emergency room with a 24-hour history of abdominal pain, distention, and obstipation. Physical examination reveals a temperature of 38.6° C, abdominal distention, and diffuse abdominal tenderness. Abdominal x-rays show marked colonic dilatation, most pronounced in the transverse colon. Laboratory examination reveals a white blood count of 19,000/mm3. Over the first 24 hours of hospitalization, symptoms are progressive in spite of intravenous fluid resuscitation, nasogastric suctioning, and intravenous antibiotics. The most appropriate management for this patient would include which of the following?
A. Decompressive colonoscopy B. Proctocolectomy with formation of end ileostomy C. Total abdominal colectomy with formation of Hartmann pouch and end ileostomy D. Cecostomy