80 year-old woman presented with abdominal pain and bloody diarrhoea.
She was operated because of peritoneal sign and clinical diagnosis of ischemic bowel. Laparotomy revealed full-thickness gangrene of 30cm mid-jejunum, and partial small bowel resection was done. Post-operative course was rapidly deteriorating in terms of biochemistry and hemodynamics. On day 2 after operation, lactate >20 (ref <1.45), BE -22, pH 7.10, ALT 2400, INR 4.5. Further extension of bowel ischemia was suspected. Contrast CT abdomen was done to visualize any pathology before second-look laparotomy.
What ARE the problems?
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Aortic thrombus + splenic artery thrombus + portal vein thrombosis
