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Answer 1
  1. Abdominal radiographs. Although most patients with abdominal pain do not have complications during colonoscopy, this patient may have sustained a colonic perforation during the procedure. Many patients have some pain and abdominal distension as a result of retained air that was used for insufflation during the examination, but this often improves with observation. The presence of a perforation should be excluded given this patient’s severe pain. If a perforation is present, the lack of peritoneal signs may be due to the fact that it may be too soon for them to develop. Abdominal radiographs will quickly determine whether or not the patient has free intraperitoneal air, a sign of perforation. A CT scan would provide similar information but would likely take longer to obtain at greater expense. Abdominal ultrasound would not be helpful in this setting, as any free air could easily go undetected. Surgical consultation may be warranted but should wait until the results of the radiographs are available.

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