A change on an electrocardiogram not to be missed
An 80 year old woman with a history of severe vascular dementia presented to the acute surgical unit. A collateral history given by staff at her nursing home stated she had had seven days of abdominal pain associated with vomiting. She had not opened her bowels for many days. Medical history included stroke and hypertension. She had no surgical history. At the time she was taking aspirin, ramipril, and simvastatin.
On examination her pulse rate was regular at 98 beats/min, blood pressure was 132/84 mm Hg, respiratory rate was 12 breaths/min, she had a temperature of 37.1°C, and her oxygen saturations were 96% on room air. Her abdomen was visibly distended and felt firm on palpation, but neither guarding nor organomegaly was detected. A plain abdominal radiograph showed dilated bowel loops. A computed tomography scan did not show evidence of mechanical bowel obstruction. She was treated for pseudo-obstruction with a