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Clue to a more serious diagnosis
  1. B Abboud1,
  2. W Mchayleh1,
  3. G Sleilaty2,
  4. C Yaghi3
  1. 1Department of General Surgery, Hotel Dieu de France Hospital, Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
  2. 2Department of Cardiovascular and Thoracic surgery, Hotel Dieu de France Hospital, Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
  3. 3Department of Gastroenterology, Hotel Dieu de France Hospital, Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
  1. Correspondence to:
    Dr B Abboud
    Department of General Surgery, Hotel Dieu de France Hospital, Alfred Naccache Street, Beirut, Lebanon; dbabboudyahoo.fr

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Clinical presentation

An 82 year old non-diabetic man on haemodialysis three times a week presented with a two day history of epigastric pain with nausea, fatigue, and a cold painful left lower extremity. He complained of chronic claudication after an ambulatory distance of 50 m and a two month history of postprandial abdominal discomfort. Physical examination revealed isolated epigastric tenderness, absent left femoral pulse, and a cold insensitive left lower extremity. Rectal examination was normal. Leucocytosis of 34 000/mm3 (80% polymorphonuclear) was the only striking biological abnormality. Immediate enhanced computed tomography scan of the abdomen (fig 1) was obtained and upper endoscopy was performed (fig 2).

Figure 1

 Enhanced computed tomography scan of the abdomen.

Question

How can these examinations help in integrating the whole clinical syndrome?

See page 487 for answer

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Footnotes

  • Robin Spiller, Editor

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