A 38 year old male with no identifiable co-morbidities presented to the emergency department complaining of a 2-day history of progressively worsening abdominal pain, nausea, intractable vomiting and shortness of breath. Examination reveals tachycardia, respiratory distress, and abdominal pain out of proportion to the palpation. Apart from mild leukocytosis and a lactate of 2.2 mmol/L, D-Dimer 2100 ng/ml. All other laboratory investigations were normal. After normal plain films of the abdomen and chest, the patient underwent a computed tomography (CT) scan of the abdomen with contrast.\nThe scan revealed extensive thrombosis of the portal, splenic, superior and inferior mesenteric veins. The mid-portion of the small bowel was suggestive of venous ischemia. No pneumatosis intestinalis was noted. An incidental finding of a totally occluded right pulmonary artery consistent with a pulmonary embolism was noted.\nThe patient received heparin therapy prior to a diagnostic laparoscopy. Intra-operatively a markedly dusky jejunal segment was identified along with turbid fluid in all quadrants. Conversion to open laparotomy ensued followed by resection of the diseased segment with temporary abdominal closure (). The patient was admitted to the ICU for resuscitation and anticoagulation. The patient was later taken to theatre for a side to side anastomosis. The patient was subsequently placed on extracorporeal membrane oxygenation (ECMO) and is currently under care in the intensive care unit (ICU).
A 38 year old previously healthy male presented to our ER complaining of a 2 day history of worsening left arm pain and mild shortness of breath. On examination a discolored left arm was noted and markedly reduced/absent pulses. The patient was afebrile and the only abnormal laboratory investigations was a D-Dimer of 1500 ng/ml. CT-angiography showed a totally occluded left axillary artery and partial occlusion of the brachial artery - likely embolic. Bilateral pulmonary embolism noted on subsequent CT scan.\nHeparin infusion was initiated and a surgical embolectomy performed successfully. The patient was admitted to the ICU for observation management. The patient recovered and was discharged after 2 weeks.