0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Special Feature |

Image of the Month—Quiz Case FREE

Satoshi Ogiso, MD; Gen Nishikawa, MD; Hiroaki Hata, MD; Takashi Yamaguchi, MD; Nobuyuki Tsuchiya, MD
[+] Author Affiliations

Author Affiliations: Kyoto Medical Center, Kyoto, Japan.


Section Editor: Carl E. Bredenberg, MD


Arch Surg. 2010;145(10):1017. doi:10.1001/archsurg.2010.221-a.
Text Size: A A A
Published online

A 53-year-old man who had no previous illness recorded had severe paraumbilical pain and underwent open cholecystectomy in which cholecystic and hepatic infarctions were found. A computed tomographic scan of the abdomen and pelvis obtained at postoperative evaluation showed sporadic hepatic infarction (Figure 1) and intestinal dilatation. Three-dimensional reconstructed images of the computed tomographic scan revealed occlusions at the origins of the celiac axis and superior and inferior mesenteric arteries but maintained blood flow in their distal lesions (Figure 2). Abdominal angiograms identified collateral flows from the left internal iliac artery to the superior mesenteric artery through the superior rectal, left colic, and middle colic arteries (Figure 3). Then, intravenous low–molecular weight heparin and prostaglandin E1 were administered. Seven days after the surgery, he developed relapsing abdominal pain, and relaparotomy was performed for the resection of an infarcted small intestine and right colon. Anticardiolipin and anticardiolipin β2-glycoprotein I complex antibodies were detected at 1 and 13 weeks after the second surgery. He was discharged after the administration of total parenteral nutrition and chronic anticoagulation with Fondaparinux but developed ischemic pancreatitis 8 months after the second surgery.

Place holder to copy figure label and caption
Figure 1.

A computed tomographic scan shows sporadic hepatic infarction.

Graphic Jump Location

Place holder to copy figure label and caption
Figure 2.

Three-dimensional reconstructed images of the computed tomographic scan revealed occlusions at the origins of the celiac axis and superior and inferior mesenteric arteries but maintained blood flow in their distal lesions.

Graphic Jump Location

Place holder to copy figure label and caption
Figure 3.

Abdominal angiograms identified collateral flow from the left internal iliac artery to the superior mesenteric artery through the superior rectal, left colic, and middle colic arteries.

Graphic Jump Location

WHAT IS THE DIAGNOSIS?

A. Atherosclerotic disease

B. Heparin-induced thrombocytopenia

C. Antiphospholipid antibody syndrome

D. Disseminated intravascular coagulation

Figures

Place holder to copy figure label and caption
Figure 1.

A computed tomographic scan shows sporadic hepatic infarction.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 2.

Three-dimensional reconstructed images of the computed tomographic scan revealed occlusions at the origins of the celiac axis and superior and inferior mesenteric arteries but maintained blood flow in their distal lesions.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 3.

Abdominal angiograms identified collateral flow from the left internal iliac artery to the superior mesenteric artery through the superior rectal, left colic, and middle colic arteries.

Graphic Jump Location

Tables

References

Correspondence

CME
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Articles Related By Topic
Related Collections