Presentation
Abdominal pain and vomiting. known case of cystic fibrosis.
Patient Data
The liver has nodular surface and atrophic, in keeping with cirrhosis. Dilated paraumbilical vein and large number of varices around the distal esophagus, splenorenal, as well as splenic hilum, features of portal hypertension. Splenomegaly is also seen.
The small bowel loops are distended, with small bowel feces signs seen in the distal ileum, leading to a transition point, from there the distal and terminal ileum are collapsed. No enhancing mass can be seen. No abnormal bowel wall thickening or hyperenhancement seen.
The pancreas is atrophic with fatty replacement, in keeping with the known history of cystic fibrosis.
Portal vein as well as splenic and SMV appear patent.
Minimal ascetic free fluid.
Interpretation
- acute small bowel obstruction, with transition point in the distal ileum (distal intestinal obstruction syndrome)
- features of cirrhosis and portal hypertension
Case Discussion
CT of the abdomen of a 25-year-old patient with known cystic fibrosis (CF) presents with distal intestinal obstruction syndrome.
The liver is markedly nodular in contour in keeping with advanced cirrhosis and extensive dilated portosystemic collaterals are seen, consistent with portal hypertension. The spleen is also markedly enlarged. Also, note the complete fatty atrophy of the pancreas - a feature of cystic fibrosis.
The small bowel is dilated and fluid-filled bowel all the way to the distal ileum.
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