Case history
Case history #1
A 48-year-old man presents with intermittent diffuse abdominal pain, worse after eating meals. The pain has been present for the previous 6 months, but has worsened recently. He has had significant weight loss since the onset of symptoms. His past medical history includes systemic lupus erythematosus, which has been difficult to manage medically.
Case history #2
A 78-year woman with a recent history of myocardial infarction and atrial fibrillation presents with sudden onset of severe, continuous, and diffuse abdominal pain, nausea, and bloody bowel movements. She is diaphoretic, tachycardic, and hypotensive, and appears very unwell.
Other presentations
Up to 6.7% of patients who have undergone open or endovascular cardiac or major vascular procedures develop colonic ischemia; mortality may be as high as 80% in this population.[2][3] Surgical management of thoracic and abdominal aortic aneurysms (AAAs) is strongly associated with bowel ischemia; prevalence following repair of ruptured AAA is up to 10% and after elective endovascular repair incidence is up to 2.8%.[3][4] These patients typically present with crampy abdominal pain and watery diarrhea within a few days of surgery. Factors that may underlie these figures include emboli arising from cross-clamping of the aorta, a risk of intestinal hypoperfusion in the postoperative period, and a relatively high incidence of heart failure in these patients. Significant risk factors for mesenteric ischemia post cardiac surgery include advanced age (>70 years), prolonged bypass time, emergency surgery, higher volume of blood loss, and other evidence of postoperative organ dysfunction, such as a rise in lactate, transaminases, and creatinine.[5][6]
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