Medical Case: Less Common Causes of Sudden, Severe Abdominal Pain


Q: A 63-year old man presented with abdominal pain, of sudden onset. the pain was situated across the central abdomen and whilst initially mild, had increased in severity, being continuously present with little fluctuation in it's intensity, . soon after the onset of pain he developed an urge to defecate, the stools appearing normal . the patient had atrial fibrillation ; there was little abdominal tenderness and on other intra-abdominal abnormality. investigations showed a leucocytosis of 15.7 thousand and mild metabolic acidosis. chest X-ray showed no abnormality but electrocardiogram revealed atrial fibrillation. what is the diagnosis? what further investigations may be helpful?


A:   Given the history of atrial fibrillation in this 63 year old man, I would seriously consider mesenteric ischemia. Atrial fibrillation and other arrhythmias will predispose patients to increased clotting tendencies; if the clot occludes mesenteric vessels, mesenteric ischemia may ensue. A hallmark of this condition is abdominal pain out of proprtion to tenderness. Stool occult blood test may be done. Other investigations which can be helpful are mesenteric angiography (to identify the specific blood vessel occluded) or CT scan. In cases wherein peritoneal signs are present (rigid abdomen, hypoactive bowel sounds), emergent laparotomy is warranted. I do hope I answered your question. Take care always.

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