Case

A patient presents with pain and cramping in their abdomen as well as nausea and vomiting. The patient describes feeling an urgency to defecate and there is considerable blood in their stool. Imaging shows significantly atherosclerosis buildup restricting blood flow into both the superior and inferior mesenteric artery.  

Question 1/2 - What condition do you think this patient has?

Click on your selected option(s) below  (correct = 1, possible = 2, over-thinking = 3+)

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Possible, but as an adjunct to another condition that is more likely. Blood in the stool indicates there is bleeding into the lumen of the intestinal tract. In a perforation we are also concerned about GI tract contents entering the peritoneum (risk of infection leading to sepsis).

Incorrect. Obstruction would reduce or block the ability to defecate, while the patient has an urgency and blood in the stool indicating defecation is occurring.

Incorrect. Obstruction would reduce or block the ability to defecate, while the patient has an urgency and blood in the stool indicating defecation is occurring.

Incorrect. Bleeding from an aneurysm would be into the retroperitoneal space or into the peritoneal space, depending on severity. This would not result in blood within the stool.

Correct! The restriction of both superior and inferior mesenteric arteries by the plaques is of high concern that there is insufficient blood reaching midgut (superior mesenteric artery territory) and hindgut (inferior mesenteric artery territory). This restriction could result in ischemia, death of bowel wall, and debris/blood entering the stool from the necrotic tissue. Nausea and vomiting are also indicative of a GI tract disruption.