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A Case of the Week

Case 130

 A fifty four-year-old female presented in our hospital at night suffering from intermittent abdominal pain from approximately 2 pm. She experienced loose stool before abdominal pain. She felt tenderness in the right abdomen. She had received total gastrectomy, cholecystectomy and splenectomy because of advanced gastric cancer, 15 months ago. Body temperature 38.5C. Blood pressure 176/85 mmHg. Laboratory test on the day revealed LDH 279 U/L, CPK 156 U/L, CRP 0.31 mg/dL, WBC 9980/μL, Neutrophils 81.7%. Abdomen CT was undertaken for further investigation. Laboratory test on the following day revealed PTINR 1.74, prothrombin time 16 sec (11-13), D dimer 38.8 μg/mL (> 0.5), procalcitonin > 100 ng/mL (> 0.5). She experienced massive watery diarrhea both on the day and on the following day. On the midnight two days later, her blood pressure was suddenly reduced, leading to cardiac arrest. Immediately after advanced cardiac life support, her cardiac output was recovered.

Based on clinical findings and abdominal CT, what is your diagnosis ?

1. Enteritis

2. Colitis

3. Sepsis

4. Overwhelming post splenectomy syndrome

5. All


2018.11.21



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