Acute mesenteric ischaemia — 78F AF, pain out of proportion

Setting

You are the surgical registrar at Korle Bu. It is 22:00. The medical team refer a woman with abdominal pain who has 'a soft abdomen but she can't stop screaming'. Radiology is available; interventional radiology is on-call.

Patient

Mrs A, a 78-year-old retired seamstress, presents with 6 hours of central abdominal pain that came on suddenly at supper. She has permanent atrial fibrillation, warfarin was stopped 8 days ago for a dental extraction and not restarted. Vitals: BP 138/78, HR 118 irregularly irregular, T 37.4, lactate 4.2. Abdomen is soft, non-tender to light palpation, but she is in severe distress and vomiting bile.

Reference stack

Bailey & Love 28e Ch 65 · Sabiston 21e Ch 47 · WSES 2017 acute mesenteric ischaemia · ESVS 2020 mesenteric