A 74-year-old woman was transferred by ambulance from a nearby general medicine clinic to the Emergency Department (ED) for decreased blood pressure and abdominal pain. The patient had been undergoing a colonoscopy for persistent heme-positive stools. Shortly after insufflation of the colon, she began to complain of severe diffuse abdominal pain. On arrival in the ED, she had an initial right arm blood pressure of 85/45 mm Hg. Her physical examination was remarkable for a tense, distended abdomen. She had warm, pink upper extremities and mottled, cyanotic lower extremities with diminished pulses. Abdominal radiographic images were obtained (Figures 1,2).
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