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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).
How can these examinations help in integrating the whole clinical syndrome?
See page 487 for answer
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