Hypothermia and the acute abdomen

A 64-year old man presented to A&E with a 24 h history of persistent hypothermia and increasing confusion. His medical history included congestive heart failure, hypertension and intermittent claudication secondary to distal abdominal aortic occlusion. Examination revealed profound hypothermia-31°C, bilateral reduced power in the lower limbs and no palpable peripheral pulses. Initial blood tests revealed a metabolic acidosis with hyperlactactaemia, neutrophilia and deranged electrolytes. CT scan of the abdomen revealed extensive thromboemobolic disease of the abdominal arterial tree and diagnosed acute mesenteric ischaemia. The patient was taken to theatre where an emergency laparotomy demonstrated a perforated duodenum, which was subsequently patched, followed immediately by an axillofemoral bypass with subsequent femoral-femoral crossover. Sadly, the patient passed away shortly after completion of surgery.