Key result
An acute surgical condition (necrotic bowel) presented with chest pain, electrocardiographic changes, and rising troponin levels, mimicking acute coronary syndrome.
Case Report (n=1)
Highlights the diagnostic challenge of distinguishing primary acute coronary syndrome from secondary myocardial injury (Takotsubo-like) induced by acute noncardiac surgical conditions like necrotic bowel.
Although chest pain in association with ST-segment electrocardiographic deviation is often indicative of cardiac ischemia, it has also been associated with noncardiac conditions. The case of a 63-year-old woman that we report here is extraordinary because her presentation of "acute abdomen" did not appear severe enough to warrant urgent surgical intervention, whereas the chest pain and electrocardiographic changes (supported by rising troponin levels) created strong clinical suspicion of acute coronary syndrome. Was the evidence of cardiac ischemia a primary event, or was it a sequela of an acute surgical condition? Noncardiac surgical cases associated with evidence of myocardial injury can be extremely challenging from a diagnostic and management perspective. We believe that the accuracy of the clinical diagnosis is crucial to a well-considered approach.
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Koci et al. (2014) conducted a case report in Necrotic bowel inducing Takotsubo-like myocardial injury (n=1). Necrotic bowel was evaluated. An acute surgical condition (necrotic bowel) presented with chest pain, electrocardiographic changes, and rising troponin levels, mimicking acute coronary syndrome.
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