08-18-2014, 11:20 AM
A 28-year-old man presents to the emergency department because of vague periumbilical abdominal pain that over the next 12 hours migrates to the right lower quadrant. He has no medical history, has never had surgery, and takes no medications other than an occasional multivitamin. He is diagnosed with acute appendicitis and taken to surgery, which reveals a friable, inflamed appendix without evidence of perforation. The appendix is successfully removed, but because of diffuse inflammation, the surgeon converts the laparoscopic procedure to an open one. The patient is admitted to the surgical floor following an uneventful recovery in the postanesthetic care unit. The following day he notices a significant amount of bleeding from the wound site. His surgeon evaluates him and decides to take him back to the operating room for wound exploration and reclosure. During the second surgery, no bleeding vessel is identified and hemostasis is readily achieved with electrocautery. The surgeon takes special care to close the wound this second time. However, the following day the gauze dressing is soaked with blood once again. The complete blood cell count, prothrombin time, International Normalized Ratio, partial thromboplastin time, and bleeding time are within normal limits.
What test would support the diagnosis?
A.1:1 Mixing study
B.Anticardiolipin antibody assay
C.Antiglycoprotein IIb/IIIa antibody assay
D.Bone marrow biopsy
E.Urea clot stability