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Abdominal pain and distension

Correspondence to:
Correspondence to:
Professor A M Kaiser
USC Department of Colorectal Surgery, 1441 Eastlake Ave, Suite 7418, Los Angeles, California 90033, USA; akaiser@usc.edu

Keywords: mesenteric ischaemia; arteriosclerosis; computed tomography; portal vein gas

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Clinical presentation
An 81 year old woman with a history of hypertension, diabetes, and peripheral arterial disease presented with acute onset of abdominal pain and distension. The patient also reported lack of bowel movements but denied any nausea or vomiting. On clinical examination, she was alert and fully oriented. The patient was ambulating or sitting in a chair. Her vital signs were normal except for an elevated systolic blood pressure. However, the abdomen was distended and tender to palpation with peritoneal signs and hypoactive bowel sounds. A computed tomography scan of the abdomen with oral and intravenous contrast was obtained.

Question
Was is the diagnosis and what is the prognosis?

See page 491 for answer

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View larger version (70K): [in this window] [in a new window]   Figure 1  Computed tomography scan of the abdomen with oral and intravenous contrast.