Patient: Julia Jackson Julia Jackson is an 84-year-old woman who presents to the Emergency room with severe abdominal pain, especially in the left lower quadrant. An abdominal CT was ordered, and it found that there is a 5cm mass in the lower sigmoid colon with fecal impaction. The patient was admitted to the Med/Surg floor for treatment and resolution of fecal impaction. An oncology consult order was entered. The patient stated she has abdominal pain of 8 out of 10.

Introduction

Abdominal pain is a common symptom experienced by patients presenting to the emergency room. It can arise from various causes, including gastrointestinal disorders, urinary tract infections, or musculoskeletal issues. In the case of Julia Jackson, an 84-year-old woman, her severe abdominal pain localized to the left lower quadrant raises concerns about the underlying cause. This paper aims to analyze Julia’s presentation and potential diagnosis based on the available information, as well as discuss further investigation and management options.

Clinical Presentation

Julia Jackson’s main complaint is severe abdominal pain, specifically in the left lower quadrant. This localized pain can provide valuable diagnostic information, as different regions of the abdomen correlate with various organs and structures. The left lower quadrant is primarily associated with the sigmoid colon, although other structures like the descending colon and left ovary can also cause pain in this area (Marieb & Hoehn, 2013). Therefore, it is important to consider both gastrointestinal and gynecological causes.

Diagnostic Evaluation

To further investigate the cause of Julia’s abdominal pain, an abdominal CT scan was ordered. The imaging study revealed a 5cm mass in the lower sigmoid colon with fecal impaction. This finding is significant as it suggests a possible obstruction in the colonic lumen, resulting in fecal impaction and subsequent pain (Curry & Wilson, 2011). The presence of a mass raises concerns about malignancy, and an oncology consult order has been entered in Julia’s case. However, additional information is needed to confirm the diagnosis and develop an appropriate management plan.

Differential Diagnosis

Given Julia’s age and the presence of a mass in her sigmoid colon, it is crucial to consider colorectal cancer as a possible diagnosis. Colorectal cancer is a common malignancy worldwide, and its incidence increases with age (Siegel et al., 2020). The presence of fecal impaction, although not specific to cancer, can be a sign of an obstructive process. Other possible differential diagnoses include diverticulitis, diverticular abscess, or a volvulus. A diverticular abscess could cause similar symptoms and would require prompt management, including antibiotics and possibly surgical intervention (Maconi et al., 2019). A volvulus occurs when a segment of the colon twists on itself, leading to bowel obstruction, ischemia, and potential necrosis (Nishiyama et al., 2018). Imaging studies, such as a barium enema or colonoscopy, may be necessary to differentiate these conditions and confirm the diagnosis.

Treatment and Management

Julia Jackson has been admitted to the Med/Surg floor for treatment and resolution of fecal impaction. The primary goal is to relieve her symptoms and prevent complications. Initial management may include conservative measures, such as bowel rest, hydration, and the use of stool softeners or laxatives. Manual disimpaction may be attempted, but in cases where this is unsuccessful or if there are concerns about an underlying obstruction, a more aggressive approach may be required.

Given the presence of a mass and concerns for colorectal cancer, an oncology consult has been ordered. Once confirmed, the appropriate management plan can be developed, which may include surgical intervention, chemotherapy, and/or radiation therapy. The treatment approach will depend on factors such as the stage of the cancer, the patient’s overall health, and the availability of local resources.

Conclusion

Julia Jackson’s presentation of severe abdominal pain in the left lower quadrant and the findings on her abdominal CT warrant further investigation to identify the underlying cause. While a definitive diagnosis is yet to be confirmed, it is important to consider colorectal cancer given her age and the presence of a mass with fecal impaction. Appropriate imaging studies and consultations with specialists, such as oncology, gastroenterology, and surgery, will be essential in confirming the diagnosis and developing an appropriate management plan. Timely intervention is crucial to alleviate symptoms, prevent complications, and improve overall patient outcomes.