Presentation
Abdominal pain.
Patient Data
Small bowel is massively dilated, thick-walled, and filled with fecalized material.
Ill-defined transition point in the pelvis with heterogeneous enhancement.
Small amount of free intraperitoneal air.
SMA is thrombosed proximally with minimal distal reconstitution of a few branches, likely via IMA collaterals. Celiac origin is narrowed due to median arcuate ligament impression.
Poor filling of SMV.
Heteregenous perfusion of the liver and spleen.
Case Discussion
Dramatic case of a late presentation of mesenteric ischemia, obstruction, and perforation.
The SMA thrombosis does not appear acute given the relatively small caliber, and may well be a chronic finding. A possible course of events could be (1) chronic mesenteric ischemia (2) developing small bowel obstruction (3) progressively worsening ischemia resulting in stasis and fecalization (4) perforation.
Unfortunately, I am not able to determine the cause of obstruction/abnormal enhancement in the pelvis.
Unable to process the form. Check for errors and try again.