A 30-Year-Old Man Comes to the Emergency Department with a 4-Day

A 30-year-old man comes to the emergency department with a 4-day history of progressively worsening abdominal pain and bloody diarrhea.  He was started on mesalamine therapy 6 months ago after being diagnosed with ulcerative colitis but has been noncompliant with treatment.  His temperature is 38.8 C (102 F) , blood pressure is 100/70 mm Hg, and pulse is 130/min.  The patient is lethargic and has dry mucous membranes.  There is marked abdominal distension and tenderness without rebound or guarding.  Rectal examination shows guaiac-positive, maroon-colored, liquid stool.  Which of the following is the best next step in this patient's workup?

A) Abdominal ultrasonography
B) Barium enema
C) Colonoscopy
D) Plain abdominal x-ray
E) Small-bowel contrast study

Correct Answer:

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