Elderly Woman With Abdominal Pain

An 81-year-old woman was taken to the emergency department after a few days of worsening abdominal pain and deteriorating level of consciousness. She had extensive peripheral vascular disease and had recently required endarterectomy to salvage an acutely ischemic limb. On admission, she was profoundly hypotensive, tachypneic, and oliguric because of a state of circulatory shock, and the abdominal examination was characterized by generalized tenderness and reduced bowel sounds, without rebound or guarding.

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