History of Present Illness:
A female in her mid 80’s with a history of stroke and dementia is brought to the ED for 1 day of generalized abdominal pain. She has poor memory but doesn’t think she has vomiting. Her daughter is worried about bleeding because her stool was dark and she takes Eliquis.
Vital Signs & Physical Exam:
Vital signs are normal except for a pulse of 104, 0. Physical exam is notable for rebound tenderness
Initial Diagnostic Testing:
- Imaging:
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What is the most likely diagnosis?
- A) Perforated viscus
- B) Mesenteric Ischemia – CORRECT –
- C) SBO
- D) PUD with active bleed
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What is the most likely diagnosis?
- A) Perforated viscus
- B) Mesenteric Ischemia – CORRECT – there is a section of bowel that is not enhanced (just anterior to the lower pole of the kidney)
- C) SBO
- D) PUD with active bleed
1-Minute Consult on this topic: Click HERE and scroll to proper page
CASE CONCLUSION: IR and G-surg consulted. Started on heparin and admitted to ICU for close observation. No intervention planned initially as occlusion was in the distal SMA with only a small area of SI at risk
CASE LESSONS: Eliquis is most often for a-fib meaning you patient is not only at risk for bleeding but also for embolism to brain, heart, leg, intestines, kidney….