A 26-Year-Old Woman Is Evaluated for Intermittent Abdominal Pain Occurring

question 748

Multiple Choice

A 26-year-old woman is evaluated for intermittent abdominal pain occurring over the last several years.  The pain is crampy without radiation and graded 6/10 in intensity.  She also has fluctuating diarrhea but has not seen blood in the stool.  The patient has no nausea, vomiting, constipation, urinary frequency, dysuria, or vaginal symptoms.  Her last menstrual period was 2 weeks ago.  She does not use tobacco or alcohol.  Temperature is 37.2 C (99 F) , blood pressure is 115/70 mm Hg, and pulse is 90/min.  On examination, the abdomen is tender without guarding or rebound.  There is a draining fistula near her coccyx.  Which of the following is the most likely diagnosis in this patient?

• A)Crohn disease
• B)Diverticulitis
• C)Intergluteal pilonidal disease
• D)Irritable bowel syndrome
• E)Ulcerative colitis

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