PMC5390630_01
Abdominal X-ray showing scattered air-fluid levels in minimally prominent small bowel loops (case  1).
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fig1
Scattered air-fluid levels indicating small bowel obstruction were seen on erect abdominal X-ray (Figure 1).
Dilated multiple loops of proximal small bowel with collapsed distal loops of small bowel consistent with small bowel obstruction (case  1).
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fig2
Computer tomography confirmed the diagnosis (Figure 2).
ST elevation in inferior and lateral leads (case  1).
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fig3
To our surprise, the ECG showed sinus tachycardia with inferolateral ST elevation (Figure 3).
Resolution of ST elevation in inferolateral leads after surgical decompression (case  1).
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fig4
Soon after laparotomy and resolution of obstruction, the dramatic ECG changes disappeared (Figure 4) while the cardiac biomarkers remained negative making an acute coronary event unlikely.
PMC5390630_02
ST elevations in leads II, III, aVF, V5, and V6 (case  2).
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fig5
However, in the emergency room, ECG demonstrated ST elevations in leads II, III, aVF, V5, and V6 (Figure 5).
Coronary angiography showing no obstructive coronary artery lesions responsible for ST elevation (case  2).
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fig6
This revealed no angiographic evidence for obstructive coronary artery disease (Figure 6) but an abnormal left ventricular systolic function with ejection fraction around 35%.
Resolution of ST elevation after surgical intervention (case  2).
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fig7
Repeat ECG immediately after the surgical procedure revealed resolution of ST elevation in inferior and lateral leads (Figure 7).