Figure 1. Pelvic CT.
ECG showed left ventricular hypertrophy but no conduction problems. Patient’s abdominal CT with contrast revealed a critical stenosis of celiac trunk (95%), for which patient was consulted with interventional radiologist.
On physical examination the patient appeared well with no abnormal findings. On rectal examination there was a fresh blood on a glove.
While getting a disease history, it was noticed that the patient complained on chest pain that bothered patient for several years. The patient had a history of arterial hypertension for few decades and was consulted by cardiologist few times a year for medication adjustments. However, since she was living in a rural place, she never had an echo of the heart and other diagnostic procedures. A cardiologist was invited to consult patient before surgery. A patient underwent heart CT with contrast that revealed severe obstructive coronary artery disease: LCx distal - 95%, RCA distal - 90-95%, PLb prox - 95% (Figure 2). After a discussion with multidisciplinary team, as there was local form of a tumor of the rectosigmoid part of colon with bleeding, patient was advised to undergo a simultaneous surgery to treat heart disease and rectal cancer in one surgery. However, patient declined this treatment despite doctors’ recommendations and was discharged.