●A 29-year-old male who presented with peritonitis and pneumoperitoneum and underwent an emergency exploratory laparotomy.

●A brachial arterial line was placed due to septic shock and inability to access the radial artery; the patient subsequently had a total colectomy for CMV colitis.

●Postoperatively, the patient’s limb showed mottling and significant clot formation at the arterial line site, confirmed by ultrasound.

●Initial treatment included a heparin drip followed by thrombectomy; however, multiple thrombectomies and a hematoma cut-down were required, ultimately resulting in an above-the-elbow amputation.

●Workup revealed no underlying hypercoagulable disorder; the arterial thrombus was likely due to low venous flow and stasis from hypotension related to septic shock.