An 80-year-old man presented with renal failure and mild abdominal pain. He had a history of right colon resection for cancer, CABG X4 (see CABG) and chronic atrial fibrillation for which he was anticoagulated. His white blood cell count was 20,000 with a left shift, creatinine was 8 and his INR was 3. He was afebrile, and examination of the abdomen was significant only for mild right periumbilical tenderness without guarding, rebound or mass.
In addition, there was air in intrahepatic portal vein radicals. The patient was transfused with fresh frozen plasma to correct the clotting deficit, and taken to the operating room with the presumptive diagnosis of dead bowel, probably from embolus secondary to atrial fibrillation, and pylephlebitis.
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