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Answer 4
  1. SMA occlusion. The patient is experiencing an acute arterial occlusion, most likely from an atheromatous embolus. The acute onset of pain and elevated lactate level, coupled with a radiograph suggestive of an ileus and the lack of peritoneal signs, make such an occlusion likely. Acute pancreatitis and cholecystitis are associated with abnormal pancreatic and liver chemistries, respectively. A small bowel obstruction with perforation would present with peritoneal signs and free air on the radiograph. SMV occlusion usually has a longer course before presentation. The history of a bowel movement following the onset of pain often is seen in SMA occlusion.

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