A 50-Year-Old Man Undergoes Surgery for a Peptic Ulcer Perforation

A 50-year-old man undergoes surgery for a peptic ulcer perforation.  The patient's early postoperative course is complicated by fever and hypotension, which are treated with broad-spectrum antibiotics and intravenous fluid support.  He recovers until postoperative day 7, when he develops nausea, abdominal cramps, and profuse watery diarrhea.  The patient is not currently on antibiotics.  Temperature is 38.9 C (102 F) , blood pressure is 112/70 mm Hg, pulse is 120/min and regular, and respirations are 18/min.  The lungs are clear to auscultation.  Abdominal examination shows a well-healing midline scar and no distension.  Tenderness is present in the left lower quadrant.  Testing of stool for occult blood is negative.  Laboratory results are as follows: Which of the following is the most appropriate next step in management of this patient?

A) Blood cultures and broad-spectrum antibiotics
B) CT scan of the abdomen
C) NPO and parenteral feeding
D) Stool cultures
E) Stool microscopy for ova and parasites
F) Stool PCR for Clostridioides difficile

Correct Answer:

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