Intestinal obstruction mimicking acute myocardial infarction

Abstract

A 64-year-old woman presented at our institution with abdominal pain. An electrocardiogram suggested the possibility of acute anteroseptal myocardial infarction. Her medical history included esophageal reconstruction with use of a jejunal conduit in the anterior mediastinum. Echocardiography revealed a distended jejunal conduit, which was compressing the right ventricle. Once the cause was identified, nasogastric suction was initiated and the symptoms and electrocardiographic changes resolved.

Fig. 1 A) Baseline electrocardiogram (ECG) after placement of a jejunal bypass in the anterior mediastinum shows sinus rhythm and left anterior fascicular block. B) An ECG at the time of intestinal obstruction shows ST segment elevation in leads V₁–V₃ and evidence of right atrial enlargement. C) An ECG after initiation of nasogastric suctioning shows a return to baseline.

Fig. 2 Transthoracic echocardiogram in a parasternal long-axis view shows A) diastolic and B) systolic still frames. Ao = aortic root; Je = jejunal bypass; LA = left atrium; LV = left ventricle; RV = right ventricle

Fig. 3 Abdominal radiographs with the patient in the A) supine and B) upright position show differential air-fluid levels consistent with small bowel obstruction.