Presentation
Collapse, hypotensive, abdominal pain.
Patient Data
The cecum and distal ileum demonstrate absent mucosal enhancement, with intramural gas locules.
Extraluminal gas has a curvilinear morphology suggesting it tracks within vessels in the adjacent mesentery, and small locules are identified in the superior mesenteric vein and a few of its major tributaries.
The rest of the bowel is dilated but enhances normally. No free fluid.
Infrarenal AAA measures 3.2 x 3.4 cm in maximal axial dimension, with eccentric mural thrombus. No aneurysmal rupture or retroperitoneal hematoma.
Extensive vascular calcification noted. Undermining, deep atherosclerotic ulcers are seen as well as short dissections within the common iliac arteries.
No focal liver lesion. Spleen and pancreas are unremarkable. There are bilateral small renal cysts.
Conclusion
- Ischemic gut affecting distal ileum and cecum, with intramural gas extending into the superior mesenteric vein.
- Infrarenal AAA.
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