Elderly Woman with Periumbilical Pain

Today’s case involved a 77 year old F with CAD s/p CABG 2008, atrial fibrillation, HTN, DMII who presented with 1 week of periumbilical pain with associated nausea and emesis.  Additionally, she was found to have a monocytosis as well as pre-renal azotemia. Although a poor historian, residents were able to delve into potential differentials as well as recognize the importance of completing serial exams.

Interestingly, her CT imaging revealed colitis of the cecum, but also had other concerning findings such as severe atheroslerosis of the abdominal aorta and iliac arteries, stenosis of the superior mesenteric artery and celiac trunk and sub-centimeter lymphadenopathy within the pelvic region.  Therefore, further clinical reasoning led to exploring mesenteric ischemia as a possible diagnosis.

A few clinical pearls to remember:

* There are two forms: acute etiology with a sudden onset of  abdominal pain that  is out of proportion to exam, associated  N/V, as well as chronic etiology with complaints of post-prandial pain and weigh loss, a presentation which is more insidious in nature.

*The acute form has four major causes: Arterial emboli (most common), arterial or venous thrombus, and non-occlusive event.

*Treatment range from the use of vasodilators (papaverine) to thrombectomy.

Peruse the following article ( here ) to further deepen your knowledge.