Q: What diagnosis to the aspects of the history suggest? show answer
Small bowel obstruction
Epigastric pain, vomiting, melaena. Multiple vascular risk factors.
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Multiple distended small bowel loops (positioned centrally, valvulae conniventes present).
Left hip arthroplasty noted.
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This patient progressed to have a CT which showed extensive ischaemic change throughout the small bowel.
The case was managed conservatively due the patient's co-morbidities.