There was slight reduced opacification of the left colic and sigmoidal branches of the inferior mesenteric artery relative to its terminal branch, but there was no evidence of bowel ischemia or pancreatitis.ĬT scan of the abdomen showing large bowel distention with multiple gas‐fluid levels Computed tomography (CT) mesenteric angiogram showed bowel distension with multiple gas‐fluid levels and associated rectosigmoid fecal impaction with wall thickening, which were suggestive of stercoral colitis (Figures 1 and and2). Repeat blood investigations showed rising serum lactate of 19.8 mmol/L despite fluid resuscitation. ![]() Over the next few hours, he developed guarding over the epigastrium and periumbilical region. He was provisionally diagnosed to have acute pancreatitis with high anion gap metabolic acidosis and was resuscitated with intravenous crystalloids. ![]() His serum amylase was 812 U/L (normal range 38‐149 U/L). Blood gas analysis showed metabolic acidosis with pH of 7.244, sodium bicarbonate level of 15.1 mmol/L, and serum lactate of 12 mmol/L. His blood tests showed a normal white cell count of 6.10 × 109/L. Abdominal examination revealed mild epigastric tenderness. On examination, he was afebrile, with a heart rate of 106 beats per minute, and blood pressure of 91/61 mm Hg. He had a medical history of diabetes, hypertension, and hyperlipidemia and was discharged from the hospital the day before after admission to the hospital for recurrent falls. A 72‐year‐old man presented with abdominal discomfort, vomiting, and constipation for 3 days.
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