Question 246 · LEK · Intestinal ischemia
An 83-year-old male who was treated for arrhythmia and arterial hypertension was admitted to emergency dept. due to severe abdominal pain. The pain appeared suddenly, about an hour before admission, was at first located within the epigastric region and was paroxysmal in nature. However, at the time of examination, the pain is continuous and concerns the entire abdomen area. The abdomen is bloated, and positive peritoneal symptoms are present in all abdominal quadrants. The patient has nausea and vomits with the stomach content. Peristalsis cannot be heard. Physical examination shows large inguinal hernia on the right side, and per rectum examination, brown stool in the rectal ampulla. HR: 96/min, BP: 103/57 mmHg, RR: 18/min, WBC: 33000/mm3, Hgb: 11.2 g/dl, Hct: 31%, Amylase: 140 U/l, D-dimers 15000 µg/l, Tnl: <0.001 ng/ml. ECG: without abnormalities. Indicate what is the cause of the patient’s complaints:
- A. gastric ulcer perforation.
- B. acute intestinal ischaemia.
- C. myocardial infarction.
- D. obstruction caused by colon tumour.
- E. acute pancreatitis.
Hint
Combine the arrhythmia history, sudden onset of severe pain, extreme leukocytosis and very high D-dimers with a normal ECG and troponin.
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