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Abdominal pain and shock in a 73-year-old patient
  1. Y-J Chen1,
  2. C-C Hsieh1,
  3. P-S Lai2,
  4. C-C Lee1
  1. 1
    Department of Emergency Medicine, National Taiwan University Hospital Yun-Lin Branch, Taiwan
  2. 2
    Department of Surgery, National Taiwan University Hospital Yun-Lin Branch, Taiwan
  1. Dr Chien-Chang Lee, Department of Emergency Medicine, National Taiwan University Hospital Yun-Lin Branch, No. 579, Sec. 2, Yun-Lin Road, Douliou 640, Taiwan; umealinkoping{at}yahoo.com.tw

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CLINICAL PRESENTATION

A 73-year-old man was admitted to the hospital because of crampy abdominal pain in the epigastric area, nausea, and bilious vomiting for half a day. The patient had been in stable health except for a medical history of chronic hepatitis C. His temperature was 36.2°C, pulse 64, and respirations 16. On physical examination, the abdomen was distended with hypoactive bowel sounds. A plain abdominal radiograph showed a non-significant bowel gas pattern without intraperitoneal free air. His abdominal pain was not relieved by analgesics and his blood pressure dropped to 84/52 mmHg. He was sent for abdominal CT scanning (fig 1).

Figure 1 Abdominal CT showing the intestine twisting around the superior mesenteric artery.

QUESTION

Based on the history and characteristic CT finding, what is your diagnosis?

See page 1296 for the answer.

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Footnotes

  • Competing interests: None.

  • Patient consent: Obtained.

  • Used with permission of National Taiwan University Hospital, Yunlin Branch, Taiwan.

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