A 72 year old woman presents with severe, generalized abdominal pain for 1 hour, in association with nausea, vomiting and watery diarrhea. Her medical history is significant only for well controlled hypertension for 5 years; she is currently on therapy with losartan only. A full blood count is significant for a leukocyte count of 15,000/mm3 with 90% neutrophils, while serial ECGs are only significant for atrial fibrillation. A chest x-ray, serum amylase, and serum lipase levels are found to be normal.
The abdominal x-ray appears normal.
The ultrasound scan of the abdomen appears normal.
The CT scan shows distension of the small intestine and proximal colon; CT angiography reveals occlusion of the superior mesenteric artery (SMA) close to its origin by an embolus.
You realize that colonoscopy might waste valuable time.