Résumé
An 88-year-old man presented to the emergency department with sudden onset of abdominal pain since 6 hours before. He described his pain as an epigastric pain that had become generalized without any radiation. The pain was persistent and aggravated by meal. It was associated with nausea but not with vomiting, diarrhea, hematochezia, hematemesis or dysuria. He was a known case of chronic renal failure that underwent hemodialysis three times a week. He also suffered from hypertension and benign prostatic hyperplasia. The patient was under treatment with aspirin, atorvastatin, furosemide, finasteride, and tamsulosin. He did not use cigarette, opium or alcohol. The patients' on arrival vital signs were as follows: systolic blood pressure: 100/60 mmHg, pulse rate: 88/minute, respiratory rate: 25/minute, oral temperature: 36?C, oxygen saturation 93% in room air. He had severely ill appearance on admission. Lungs and heart auscultation was normal. Distended abdomen was considerable but had normal bowel sound and clearly, pain was disproportionate to physical examination. Rectal examination was unremarkable. Pitting edema was observable on his lower limbs; however, symmetric peripheral pulses were detected. His electrocardiogram showed sinus rhythm and venous blood gas analysis revealed the following: pH=6.96, PaCO2=49 mmHg, HCO3=11 mEq/L, Base excess= -20. By reviewing the biochemistry profile only urea=180 mg/dL and creatinine=4.8 mg/dL were no table and all others such as amylase, lipase, and liver function tests were reported in normal range. The bedside ultrasonography showed echogenic particles in hepatic parenchyma and same findings that were passing through the portal vein [Figure 1]. Chest and abdominal X-rays were reported as normal. The patient underwent abdominal and pelvic computed tomography [CT] scan with oral contrast that showed in Figure 2