A 74-Year-Old Man Is Brought to the Emergency Department Due

A 74-year-old man is brought to the emergency department due to acute-onset lower abdominal and back pain that was followed by an episode of syncope 2 hours ago.  The pain is sharp and constant.  He has had no changes in bowel or bladder function.  Other medical conditions include hypertension and hyperlipidemia.  The patient has a 50-pack-year history of smoking cigarettes.  Temperature is 36.9 C (98.4 F) , blood pressure is 90/60 mm Hg, pulse is 108/min and regular, and respirations are 18/min.  BMI is 34 kg/m².  The patient is diaphoretic and appears pale.  Heart and lung sounds are normal.  Abdominal examination reveals moderate tenderness to deep palpation in the lower abdomen; there is no guarding or rebound tenderness.  Bowel sounds are normal.  Which of the following is the most likely diagnosis?

A) Acute mesenteric ischemia
B) Colonic perforation
C) Renal colic
D) Ruptured abdominal aortic aneurysm
E) Vertebral compression fracture

Correct Answer:

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