Severe Cardiomyopathy Imitating Acute Abdomen

Abstract

Introduction: A wide variety of medical conditions could imitate acute abdomen and are a leading cause for misdiagnoses and wrong decision making in emergency surgery. In order to avoid potentially harmful and serious complications for the patient, the physician must be able to obtain a proper medical history, to conduct a thorough physical exam, to order different kinds of tests and to perform right interpretation of the results. Materials and Methods: Here we present a 78-year-old man admitted to Emergency Department complaining of moderate pain in the right subcostal area and vomiting lasting 2 days. The patient reported a history of myocardial infarction with regular taking of Sintrom. The abdominal examination did not reveal a distended abdomen, guarding or rebound tenderness. Results: Laboratory evaluation revealed: leucocytes - 9.5 10 9 /L, CRP - 42 mg/L, creatinine - 162 µmol/L, INR - 6.3. Abdominal ultrasound showed 3-layered wall thickening of the gallbladder and significant dilatation of the hepatic veins. Further tests showed deterioration of the condition. A working diagnosis of severe acute cholecystitis was made. Due to inconsistency between the laboratory tests and the physical examination a diagnostic laparoscopy was performed. It revealed a moderate amount of ascites, enlarged and congested liver, swollen gall bladder with no signs of inflammation and an accidental discovery of a malignant formation situated on the transversal side of the colon. A minimal resection was performed in order to remove the obstruction. Conclusion: High-grade heart failure as a cause of the presented condition should always be considered, especially in patients over the age 60 years with previous history of acute myocardial infarction. In such cases laparoscopy offers significant diagnostic and treatment benefits as a minimally invasive procedure. In our case it helped avoiding unnecessary laparotomy and cholecystectomy and thus probably saved the life of the patient.