Thursday, August 27, 2020

acute abdominal pain with forceful evacuation of bowel.

 Q: 65 year old male presented to ED with abdominal pain. Patient described his pain as acute around the periumbilical region, associated with nausea and vomiting. Patient also described his pain first occurs with forceful evacuation of bowel. On exam, patient's pain appears way out of proportion to findings. What could be the probable etiology?

Answer: Acute mesenteric ischemia 

​The clinical exam can be very deceiving in acute mesenteric ischemia and requires a high index of suspicion. In the early stages of presentation, pain is usually way out of proportion to physical findings. Abdominal distension, rebound tenderness, and guarding are relatively late signs. Association with rapid and forceful bowel evacuation should raise a high suspicion especially in males above 60 years of age. Risk factors are advanced age, atherosclerosis, history of smoking, and cardiac disease, particularly atrial fibrillation.



1. Oldenburg WA, Lau LL, Rodenberg TJ, Edmonds HJ, Burger CD. Acute Mesenteric Ischemia: A Clinical Review. Arch Intern Med. 2004;164(10):1054–1062. doi:10.1001/archinte.164.10.1054

2. Monita MM, Gonzalez L. Acute Mesenteric Ischemia. [Updated 2020 Jun 30]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from:

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