A 41-year-old woman is evaluated in the ICU 7 days after induction chemotherapy for acute myeloid leukemia. Twenty-four hours ago she developed fever of 39.4 °C (102.9 °F) and severe hypotension and was begun on intravenous fluids, broad-spectrum antibiotics, antifungal therapy, norepinephrine, and vasopressin. Last night she developed diarrhea and a 1 g/dL (10 g/L) drop in hemoglobin.
On physical examination today, temperature is 38.1 °C (100.6 °F), blood pressure is 89/47 mm Hg, pulse rate is 100/min, and respiration rate is 22/min. Oxygen saturation is 94% on a 50% rebreather mask. Palpation of the abdomen elicits left lower abdominal pain without rebound tenderness. Liquid brown stool is present.
A review of the patient’s cardiac monitor recordings for the past 24 hours documents only sinus tachycardia.
Laboratory studies reveal a hemoglobin level of 8 g/dL (80 g/L), a leukocyte count of 150/μL (0.15 × 109/L), and a platelet count of 10,000/μL (10 × 109/L).
CT of the abdomen and pelvis reveals mild proximal jejunal wall thickening and dilation, mild mesenteric edema, and a trace amount of free pelvic fluid.
Which of the following is the most likely diagnosis for this patient’s gastrointestinal findings?
A Hemorrhage into the bowel wall
B Ischemic colitis
C Nonocclusive mesenteric ischemia
D Superior mesenteric artery embolism
Ans: B Ischemic colitis