Ischemic intestinal necrosis as a cause of atypical abdominal pain in a sickle cell patient.

The authors present a case report of a sickle cell patient with end-stage renal disease treated with peritoneal dialysis who presented with abdominal pain. Although the pain was not unlike that typically associated with his crises, the absence of characteristic joint and chest pain made the diagnosis of "crisis" unlikely and favored the admitting diagnosis of peritoneal dialysis-related peritonitis. After the patient failed to improve with a medical regimen, including antibiotics, surgical consultation was obtained. Complete small bowel obstruction and diffuse peritonitis necessitated emergency surgery at which necrosis of terminal ileum was encountered. Histologic study of the resected specimen showed microvascular thrombosis with sickled erythrocytes. The authors review this rare complication and discuss the clinical problems of diagnosing typical and atypical abdominal pain in the sickle cell patient with and without concomitant crisis.