22nd July 2023

A 63-year-old woman presents to the emergency department with a 14-hour history of constant worsening pain

A 63-year-old woman presents to the emergency department with a 14-hour history of constant worsening pain in the lower left side of her abdomen associated with 2 episodes of vomiting (food contents only). She describes the pain as “6/10 and throbbing” but denies any change in bowel habit or PR bleeding. She has a history of hypertension and type 2 diabetes, for which she takes amlodipine 5mg OD, ramipril 5mg OD and metformin 1g BD. She has no known medication allergies. On examination, she is very tender on palpation of the left iliac fossa with no rebound tenderness. PR examination is painful and reveals an empty rectum with intact anal tone and no blood. Her observations are RR 18, oxygen saturation 98% room air, HR 96 bpm and regular, BP 109/82 mmHg, temperature 38.2°C. Blood tests reveal a normocytic anaemia and raised white cell count, neutrophils, and CRP. A CT abdomen and pelvis reveals outpouchings within the bowel wall with colon wall thickening and some fat stranding.

What is the most appropriate first line management of this woman’s condition?

Select the SINGLE most appropriate option from the list below. Select ONE option only.