A 50-year-old man suffered multiple organ failure following a massive myocardial infarction. The patientís pressure was unstable, requiring pressors. Ejection fraction was 20%. He had dropped his pressure twice following dialysis in the two days prior to surgical consultation. The reason for the surgical consult was this flat plate which showed generalized ileus and a question of biliary or portal venous air (arrow).
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CT scan was obtained which showed widespread pneumatosis and air in the small bowel mesentery. The original concern regarding biliary air was interpreted as lung behind the liver. The patientís abdomen was distended and tense and the patient was febrile with a WBC of 26K. The family (patient was ventilated and sedated) was counseled regarding a diagnosis of compromised bowel and the very high mortality with and without surgery. Based on the possibility that a localized segment of dead or perforated bowel could be resected, the family desired surgical treatment.
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