Case (40)

[Mustafa]

A 60-year-old woman with premedical history of hypercholesterolaemia presents in the emergency department complaining  of a sudden onset of severe non-radiating abdominal pain,  accompanied by nausea and vomiting.
The patient perceives the pain as colicky and most severe in the midabdomen. She notes a blood in the stool.
The chest and cardiovascular exams are unremarkable, and her abdomen is minimally  tender with normal bowel sounds although writhing in pain.
Lab tests reveal only low levels of  electrolytes: bicarbonate at 15 mEq/L and high levels of lactate.

1. what is the most likely diagnosis?
2. what is your next step?
3. How do you treat this?
4. what are the possible complications?

[Yaxya]

1. what is the most likely diagnosis?
i think the most likely diagnosis is acute mesenteric ischemia .
2. what is your next step?
next step is to confirm and rule out other causes of acute abdomen since time factor is quite important because  mortality increases significantly once intestinal infarction has occurred.
tests that are usefull like Mesenteric angiography,plain abdomen and ct scan are caried out without delay.
3. How do you treat this?
Surgical: embolectomy, revascularization, or resection
Angiographic: vasodilators or thrombolysis
Long-term anticoagulation or antiplatelet therapy(heparin and warfarin).
4. what are the possible complications?
necrosis,shock and death

[Mustafa]

the answers are correct.