]> 2026-07-31T07:51:12+00:00 WBR1112 0 en Abdominal X-ray USG abdomen Laprotomy Laprotomy should not be delayed in this patient as he is suspected of having intestinal perforation. A quick diagnosis of perforation is made with abdominal X-ray before surgery is done. Mesenteric arteriography CT angiography Emergency Room A 53 year old male is brought to the emergency department with complaints of sudden onset of severe abdominal pain for the past three hours. The pain is generalized and is increasing in severity since then. He also had two episodes of non-bloody vomiting on the way to the emergency department. On further review of his history, he reveals that he was having recurrent episodes of abdominal pain for the past three months, especially after meals that persisted for one to two hours. He denies any blood or mucus in stools or any recent travel outside the country. His past history is significant for mitral valvular disease and is on ACE inhibitors and thiazide diuretics for that. He is a chronic smoker, but consumes alcohol occasionally. His family history is insignificant. On examination the patient is conscious and his vitals are pulse: 102/min, BP: 90/60 mmHg and temperature: 38 degree Celsius. Abdominal examination reveals generalized tenderness with rebound tenderness and guarding. Other system examinations are normal except for a murmur at the mitral area. The patient is kept on NPO and started on intravenous fluids and broad spectrum antibiotics. Which of the following would be the most appropriate next step in the management of this patient? A Gastrointestinal 2020-10-28T02:38:52Z 2459150.6103241 WBR1112