22nd July 2023

An 89-year-old man presents to the emergency department with lower left-sided abdominal pain

An 89-year-old man presents to the emergency department with lower left-sided abdominal pain associated with nausea and occasional PR bleeding. He reports occasionally feeling hot but is afebrile when checking his temperature at home. He has a history of diverticular disease, rheumatoid arthritis, and atrial fibrillation. He takes methotrexate 7.5mg once weekly, apixaban 5mg BD, bisoprolol 5mg OD and paracetamol 1g QDS PRN. He has no known medication allergies. His observations are HR 64 bpm, BP 122/78 mmHg, RR 18, oxygen saturation 96% on room air and temperature 36.4°C. His abdomen is soft with mild left iliac fossa (LIF) tenderness. There is no guarding, rebound tenderness or palpable masses. As he is clinically well, he is discharged back to his GP with a plan for outpatient management. He is started on oral antibiotics as he is immunosuppressed secondary to Methotrexate. He is also given dietary advice to help improve his symptoms.

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