A 39-year-old man with a history of parenteral administration of hermoin and hepatitis C, who came to the emergency department complaining of sudden epigastric pain radiating to the abdomen, agitation, and agitation.
TA: 160/60 mmHg, 75 beats per minute and temperature of 35.8 °C.
The examination revealed a soft, painful abdomen with no signs of peritoneal irritation.
Analytical: Glu 111 mg/dl, Cr 1.21 mg/dl, CPK 889 IU/l, BT 2 mg/dl, GOT 77 IU/l, troponin thorax 5 mg/l, amylase 48
Gas: pH 7.455, pO2 86, pCO2 35.9, HCO3 25.5, Sat O2 97.1%.
Abdominal X-ray: colon loops with feces.
Abdominal CT angiography: findings consistent with ischemia in SMA territory, and celiac trunk.
No flow was identified in the celiac trunk and initial course of SMA, observing the hepatic artery and spleniforms and with some contrast in distal SMA.
Signs of intestinal distress with dilated loops and pneumatosis, gas in mesenteric veins and portal gas.
Liver and spleen with ischemic appearance.
Intraperitoneal free fluid
1.
The great extent of ischemia reveals an unfortunate prognosis and discourages any aggressive surgical procedure, dying the patient within a few hours.
