A 72-year-old male presents with sudden-onset severe mid-abdominal pain out of proportion to physical examination findings. He has a history of coronary artery disease and atrial fibrillation. Abdominal examination reveals mild soft tenderness without peritoneal signs. What is the most likely diagnosis?
Answer and explanation
Correct answer: B. Acute mesenteric ischemia (superior mesenteric artery embolism)
- Step 1: The hallmark of acute mesenteric ischemia is severe excruciating abdominal pain out of proportion to unremarkable physical findings in a patient with a cardiac source for emboli (atrial fibrillation).
- Step 2: Contrast-enhanced abdominal CT angiography is the diagnostic modality of choice.
Answer
Acute mesenteric ischemia (superior mesenteric artery embolism).
Why not the others: 'Acute appendicitis' features localized right lower quadrant peritoneal tenderness; 'Ruptured diverticulitis' presents with marked left lower quadrant peritonitis and guarding; 'Small bowel mechanical obstruction' presents with distension, hyperactive high-pitched bowel sounds, and visible loops.
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