Patient selection: recent aortic reconstruction
Clinical findings:
(1) onset of intense abdominal pain
(2) diarrhea, which may be bloody
(3) progressive abdominal distention
(4) hypotension
(5) peritonitis
(6) fever
(7) sepsis
(8) renal and other organ failures
Laboratory findings:
(1) unexplained elevations of phosphorus, BUN, LDH, transaminases or other laboratory tests
(2) leukocytosis
(3) thrombocytopenia
(4) acidosis
(5) purulent abdominal fluid
(6) positive blood cultures, especially with gram-negative bacteria or enterococci
Features seen on endoscopy, which can be performed at the bedside:
(1) early - edema and petechial hemorrhage
(2) later - erosions or ulcerations with pseudomembranes
(3) advanced necrosis - yellowish or greenish color, necrotic, noncontractile surface
Complications:
(1) bowel perforation, especially after colonoscopy or barium enema
(2) sepsis
(3) infection of aortic prosthesis
(4) multi-organ failure
(5) enterocutaneous fistula
(6) bowel stricture, with or without bowel obstruction
Causes for missed diagnosis:
(1) coma
(2) ascribing abdominal findings to recent surgery
(3) failure to re-exam patient frequently
