From the Guidelines
The next best step for a patient with abdominal pain and leukocytosis is to obtain a CT of the abdomen and pelvis with contrast, as it is the most sensitive and specific imaging modality for diagnosing a wide range of abdominal pathologies, including infections, inflammation, and ischemia. This recommendation is based on the most recent and highest quality study available, which emphasizes the importance of CT scans in evaluating patients with acute abdominal pain and leukocytosis 1.
The patient's presentation with abdominal pain and leukocytosis (elevated White Blood Cell count) suggests a potential infectious or inflammatory process, and a CT scan of the abdomen and pelvis with contrast can help identify the underlying cause. The study by Peery et al. 1 highlights the accuracy of CT scans in diagnosing diverticulitis, which is a common cause of abdominal pain and leukocytosis.
Some key points to consider in the management of this patient include:
- A thorough clinical evaluation, including a detailed history and physical examination, to identify signs of peritonitis, such as rebound tenderness and guarding
- Monitoring of vital signs for evidence of systemic inflammatory response syndrome
- Consideration of empiric antibiotics if infection is suspected, with the specific regimen depending on the presumed source
- Adequate pain control, typically with IV opioids titrated to effect
- The patient should remain NPO (nothing by mouth) until the diagnosis is established and surgical intervention is ruled out
It is also important to note that while other imaging modalities, such as ultrasound and MRI, may be useful in certain situations, CT scans are generally the most appropriate initial imaging test for patients with acute abdominal pain and leukocytosis, due to their high sensitivity and specificity 1.
From the Research
Next Best Step for Patient with Abdominal Pain and Leukocytosis
The patient presents with abdominal pain and leukocytosis (elevated White Blood Cell count), which suggests a potential infection or inflammatory process. Given the patient's symptoms and laboratory results, the next best step would be to further evaluate the cause of the abdominal pain and leukocytosis.
- Imaging Studies: The patient has already undergone an abdominal x-ray, but the results are not provided. However, based on the patient's symptoms, a more detailed imaging study such as a CT scan of the abdomen and pelvis with contrast may be necessary to evaluate for potential causes of abdominal pain and leukocytosis, such as appendicitis or diverticulitis 2, 3.
- Broad-Spectrum Antibiotics: If the patient is suspected to have a complicated intra-abdominal infection, broad-spectrum antibiotics may be necessary to cover a wide range of potential pathogens 4, 5.
- CT Angiogram: A CT angiogram may be considered if there is suspicion of a vascular complication, such as pylephlebitis, which is a rare complication of intra-abdominal infections 5.
Potential Causes of Abdominal Pain and Leukocytosis
The patient's symptoms and laboratory results suggest a potential infection or inflammatory process. Some potential causes of abdominal pain and leukocytosis include:
- Appendicitis: A common cause of abdominal pain and leukocytosis, appendicitis is an inflammation of the appendix that can lead to complications such as perforation and peritonitis 4, 5.
- Diverticulitis: Another potential cause of abdominal pain and leukocytosis, diverticulitis is an inflammation of the diverticula in the colon that can lead to complications such as abscesses and perforation 4, 6.
- Intra-abdominal Infections: Complicated intra-abdominal infections, such as those caused by appendicitis or diverticulitis, can lead to leukocytosis and require prompt diagnosis and treatment 4, 5.
Given the patient's symptoms and laboratory results, the most appropriate next step would be to obtain a CT of the abdomen and pelvis with contrast to further evaluate the cause of the abdominal pain and leukocytosis, as this would provide more detailed information than an upper GI series with small bowel follow-through or a CT angiogram alone 2, 3.