Abstract
Pelvic inflammatory disease (PID) triggering adhesion-related small bowel obstruction (SBO) is rare. The occurrence of Takotsubo cardiomyopathy (TCM) with an unusually high level of troponin I in the clinical course presents a unique diagnostic challenge. We report the case of a female patient in her 40s who had repeatedly presented to the hospital with abdominal pain and initially showed signs of PID, which later developed to SBO due to adhesions requiring laparotomy. Six days post-laparotomy, she experienced chest pain with ST-segment elevation on electrocardiogram (ECG) and high troponin I level at 16,804 ng/L (reference range: 0-39 ng/L), and bedside echocardiography showed apical ballooning with severely impaired left ventricular ejection fraction. Her cardiac biomarkers and echocardiogram features improved over the next few days making TCM the likely cause, with ST-segment elevation myocardial infarction (STEMI) being the main differential diagnosis. Besides the unique series of events that created the level of complexity, this case highlighted the importance of considering PID as a potential trigger for SBO, the cautious evaluation of troponin in acute coronary syndrome (ACS)-mimicking presentation, and, above all, the necessity of timely multidisciplinary team involvement in dealing with complex cases.