Issue: 2017 > December > photo quiz

Air is everywhere

A.C. Westgeest, T. van Wesemael, M. Groenendijk
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A 71-year-old female presented to the emergency department with bloody diarrhoea and lower abdominal pain. Her past medical history included a hysterectomy and hypertension for which she took bisoprolol and felodipine. She was a non-smoker and did not use any alcohol or illicit drugs. On examination she was in pain. Her vital signs included a temperature of 35.6 °C, blood pressure 149/91 (110) mmHg, pulse rate 75/min and respiration rate 28/min. Oxygen saturation on ambient air was 98%. Physical examination revealed tenderness over the lower abdomen with muscular rigidity. Rectal examination yielded bright red blood with no palpable masses. 
The laboratory results showed elevated inflammation parameters (WBC 15.8 x 109/l; CRP 350 mg/l), slightly elevated liver enzymes (ASAT 132 U/l; ALAT 158 U/l; AP 78 U/l; gGT 133 U/l; LDH 844 U/l) and an amylase of 1524 U/l. Arterial blood gas showed a metabolic acidosis with a lactate of 10 mmol/l. The differential diagnosis included pancreatitis, (ischaemic) colitis and perforated diverticulitis. A CT abdomen was subsequently performed.