Urinary tract infection mimicking acute mesenteric ischaemia in an immunocompromised patient

Bowel infarction due to acute mesenteric ischaemia (AMI) is an abdominal emergency with a high mortality rate. We report a case of exaggerated septic response to a urinary tract infection mimicking AMI in an immunosuppressed diabetic patient. A 56-year-old female was found collapsed at home with a 24 hour history of diarrhoea, a central abdominal pain and a complex past medical history. Examination showed her to be pyrexial, drowsy, profoundly dehydrated with evidence of cardiovascular collapse. She had a tender distended abdomen, raised inflammatory markers, raised lactate of 9.1 u/L and urinalysis was positive for leucocytes and nitrites. An abdominal computed tomography (CT) scan was reported to show small bowel ischaemia. She underwent a negative laparotomy and recovered following management in the intensive therapy unit. The negative laparotomy rate can be reduced by having abdominal CT performed and reported by an experienced radiologist or by the use of diagnostic laparoscopy.