Case presentation A 83-year-old Caucasian woman was admitted to our hospital due to a low energy fracture of her left hip. The initial assessment in the Emergency Department revealed pallor, tachycardia

and a systolic blood pressure of 110 mmHg. Her past medical history included coronary artery disease, arterial hypertension and depression for which the patient was under medication over the last three years. On her way to the radiology department the patient sustained a cardiac check details arrest. Cardiopulmonary resuscitation (CPR) started immediately and she was intubated. CPR was successful and the patient was subsequently transferred to the Intensive Care Unit (ICU). During her stay in the ICU, the vasoconstricting agent noradrenaline had to be installed in order to support her circulation and selleck chemical after a few hours she developed increasing abdominal distension and severe metabolic acidocis (PH = 7.14 with

a Standard Base Excess = − 13.6 mEq/L). The patient underwent a multidetector computed tomography (MDCT) examination from the dome of the diaphragm to the symphysis pubis with a 6-row multidetector CT (Philips, Brilliance 6); using biphasic CT protocol for the abdomen without oral contrast administration. A 120 ml non-ionic contrast medium (350mg/ml iobitridol) and 50 ml of normal saline flush were administered intravenously with a power injector at a flow selleck screening library rate 3mls/s, with scan delay for starting arterial and portal-venous phases at 10s and 100s, respectively. Image acquisitions parameters were: 5 mm slice thickness, slice collimation of 1.5 mm, pitch 1, 140 kV and 120mAs. In the arterial phase, MDCT showed at least two focal areas of high attenuation (> 90 HU) within the lumen of the ascending colon and caecum suggestive of active bleeding [11]. Axial CT images at the level of the upper and the middle abdomen demonstrated thickened caecal and ascending colon wall (up to 11.5 mm) [12, 13] with increased

density due to intravenous contrast enhancement, pericaecal fat stranding and low-attenuation areas of intraperitoneal fluid at the root of the mesentery, at the perihepatic and Morrison’s spaces (Figures 1 2). No endoluminal defect of mesenteric arteries and veins was noted. Figure 1 Axial CT image at arterial phase demonstrates a Edoxaban thickened caecal wall. A focal area of high attenuation suggesting active bleeding is seen in the lumen of the caecum. Figure 2 Axial CT image at venous phase shows intraperitoneal fluid and pericaecal fat stranding. The above CT findings were suggestive of intestinal ischaemia and in association with the patient’s deterioration an exploratory laparotomy was undertaken which revealed ischaemia of the terminal ileum and extensive colonic necrosis sparing only the proximal third of the transverse colon. The rectum was also spared. The terminal ileum and the entire colon were resected and an end ileostomy was fashioned through the right abdominal rectus muscle sheath.