A 78-year-old female presents to the office with a three ...



A 78-year-old female presents to the office with a three-day history of left lower quadrant abdominal pain and fever. Past medical history is significant for hypertension and chronic constipation. She denies any previous surgeries. Additional history reveals that the patient has had a decreased appetite but no nausea or vomiting. She has had no bowel movement for four days. Vital signs reveal:

Temperature: 39.1(C (102.4(F)

Blood pressure: 148/84 mmHg

Heart rate: 102/min

Respiratory rate: 22/min

Physical examination reveals the lungs to be clear to auscultation and the heart rate regular. The abdomen is noted to have hypoactive bowel sounds and no organomegaly or masses. There is guarding and tenderness in the left lower quadrant. Palpation reveals asymmetric motion and tissue texture abnormalities at T12. The most likely diagnosis is

A) diverticulitis

B) fecal impaction

C) ischemic colitis

D) rectal abscess

E) tuboovarian abscess

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