Presentation
Abdominal pain, hematemesis and leg pain. Peritonism and signs of lower limb ischemia on exam.
Patient Data
There is a likely filling defect in the distal sub-segmental branch of the SMA. Evidence of ischemia to the mid-distal small bowel with pneumoperitoneum and free fluid likely from perforation of the ischemic bowel. There is occlusion to the common hepatic artery and the splenic artery.
There are multiple subsegmental renal infarcts.
There is occlusion to the right common iliac artery extending to the right internal and external iliac arteries with reconstitution of flow to the right SFA. There is near complete occlusion to the left internal iliac artery.
Multiple thoracic and abdominal aortic plaques are present.
Week two of admission. There are multiple hepatic, splenic, and renal infarctions. Midline laparotomy with partial colectomy with right lower quadrant ostomy and left lower quadrant colostomy. A small subphrenic collection is evident with small volume of fluid tracking along the greater curvature of the stomach. Dilation of the biliary is also seen.
Case Discussion
This is case of extensive acute widepsread thrombo-embolic disease with the patient presenting with ischemia to the small and large bowel, spleen, liver, kidneys, ovaries, and lower limbs. She was previously healthy with nil pro-thrombotic risk factors. She underwent urgent laparotomy and embolectomy with subsequent small and large bowel resections, bilateral oophorectomy, and foot amputation. The cause for this remains uncertain.