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Case Reports
. 2023 Mar 28;2023(3):rjad189.
doi: 10.1093/jscr/rjad189. eCollection 2023 Mar.

Thrombolysis of bowel obstruction? A thought-provoking presentation of a common surgical pathology

Jineel H Raythatha  1 , Bradley Tucker  2   3 , Geoffrey Lester  1   2 , Samuel Eather  2   4 , Ben Lambert  2   3
Affiliations
Case Reports

Thrombolysis of bowel obstruction? A thought-provoking presentation of a common surgical pathology

Jineel H Raythatha et al. J Surg Case Rep. .

Abstract

We present a unique case of bowel obstruction with a hiatus hernia causing atypical chest pain with dynamic ST-segment elevation in a regional Australian emergency department. The ST elevation only resolved after nasogastric decompression of the bowel obstruction. Early thrombolysis of presumed myocardial infarction led to upper gastrointestinal tract bleeding that could have been avoided with timely diagnosis. An extensive review of literature, in addition to our case report, suggests bowel obstruction is a differential diagnosis for patients who have inferior pattern ST elevation but normal troponin presenting with atypical chest pain, nausea, vomiting and previous abdominal surgery.

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Conflict of interest statement

None declared.

Figures

Figure 1
Figure 1
(A) ECG at presentation, before thrombolysis, STE in leads II, III and aVF. (B) ECG post-NG decompression of distended bowel.
Figure 2
Figure 2
(A) Coronal CT cross-section demonstrating gross bowel and stomach distension. (B) Sagittal CT cross-section demonstrating obstruction and reflux of stomach contents into oesophagus.
See this image and copyright information in PMC

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