The correct answer is B. This patient has mesenteric arterial occlusion with ischemia as a complication of an angiographic procedure. This is a typical case of iatrogenic occlusion. This patient is very susceptible to this complication because of his history of peripheral vascular disease, coronary artery disease, and severe atherosclerotic disease. Iatrogenic mesenteric ischemia occurs most commonly after angiographic procedures or operations on the aorta. Angiography may cause intestinal ischemia by dislodging of atheromata from a diseased vessel wall, by dissection of the vessel, or by formation of the intimal flap. Mesenteric ischemia is accompanied by sudden severe epigastric and mid-abdominal pain. Forceful vomiting and evacuation of stool commonly follow the onset of pain. Early after embolization, physical examination of the abdomen may be entirely unremarkable. Later, a classic presentation is severe abdominal pain out of proportion to physical exam findings may be seen. Abdominal distention, guarding, and absence of bowel sounds are associated with intestinal infarction and imply disease progression. Stool may be positive for occult blood. No laboratory tests are pathognomonic for mesenteric embolism or visceral ischemia.
Pain from a gastric ulcer (choice A) would not occur suddenly. In addition, if this patient had a perforated gastric ulcer, he would have some local signs of peritonitis, and the abdominal examination would correlate more closely with the degree of abdominal pain, unlike the situation with mesenteric ischemia.
Pancreatitis (choice C) does not occur as a result of cardiac catheterization. It can occur after endoscopic retrograde cholangiopancreatography (ERCP) with dye injection into the pancreatic duct. In addition, pancreatitis does not lead to occult blood in the stool.
Abdominal examination of a patient with a perforated duodenal ulcer (choice D) would reveal some local signs of peritonitis, and the patient's symptoms would not be so "out of proportion" to the abdominal examination.
Staphylococcal food poisoning/gastroenteritis (choice E) usually occurs three to six hours after ingestion of contaminated food. Vomiting is usually the prominent symptom with staphylococcal food poisoning.
