A 78-year-old woman presented to the emergency department with a 12-h history of sudden-onset abdominal pain. She had vomited after the pain started, and she had also had two episodes of diarrhoea. Until this time, she had been well, although she was known to be in atrial fibrillation and took digoxin 125 mg daily.
On examination, she was distressed and obviously in pain. Baseline observations revealed a pulse of 110 bpm, irregularly irregular, blood pressure of 95/60 mmHg, respiratory rate of 28 breaths/min, and temperature of 37.3 °C. Her chest was clear, heart sounds were normal (irregular rhythm), and the jugular venous pressure was not elevated. Abdominal examination was unremarkable, with a soft abdomen and minimal tenderness despite severe pain, and normal bowel sounds.
Investigations performed by the admitting surgeon updated
- 8.Bergan JJ. Diagnosis of acute intestinal ischaemia. Semin Vasc Surg. 1990;3:143–8.Google Scholar
- 21.Whitehill TA, Rutherford RB. Acute intestinal ischaemia caused by arterial occlusions: optimal management to improve survival. Semin Vasc Surg. 1990;3:149–56.Google Scholar
- 27.Rivers SP. Acute non-occlusive intestinal ischaemia. Semin Vasc Surg. 1990;3:172–5.Google Scholar
- 36.Agrawal T, Refson J, Gould S. Telly Tubby Tummy, a novel approach to the management of laparostomy. Ann R Coll Surg. 2001;83(6):440.Google Scholar
- 38.Björck M, Koelemay M, Acosta S, et al. Editor’s choice – management of the diseases of mesenteric arteries and veins clinical practice guidelines of the European Society of vascular surgery (ESVS) writing committee. Eur J Vasc Endovasc Surg. 2017;53:460–510.Google Scholar