Acute bowel ischemia

Case contributed by Dr Palak Thakrar

Presentation

Sudden onset pain in abdomen

Patient Data

Age: 30years
Gender: Male
CT

·               Transient hepatic attenuation noted in periportal  region.

·               Portal vein is dilated 16mm,  no / patchy contrast filling suggestive of thrombus.

·               Superior mesentric  vein and distal 2/3  of splenic vein also show thrombus.

·               Splenic vein at hilum appears normal.

·               The spleen is normal in size shows few  predominantly peripheral based hypodense lesions  suggestive of infarcts.

·               Small bowel loops are not  dilated , however show wall thickening.

·               Large bowel loops are collapsed  and appear normal.

Case Discussion

Affects small or large bowel, diffuse or focal

Occlusive

Arterial Occlusion- Thrombosis, atheroslcerosis, vasculitides, emboli

Venous Occlusion- Venous thrombosis, Infective/Inflammatory conditions such as- pancreatitis,

appendicitis, etc, Irradiation, trauma, chemotherapy, hypercoagulable states, carcinoma.

Non occlusive - Shock, Drugs

More commonly due to superior mesentric artery involvement

Less commonly due to superior mesentric vein.

Plain CT- Vessels- hyperdense thrombus (may not be always seen), bowel wall thickening, mesenteric fat   

stranding, free air, free fluid, portal venous gas, penumatosis

CECT- Filling defects in vessels suggestive of thrombus, bowel wall with abnormal or no enhacement

PlayAdd to Share

Case information

rID: 25196
Case created: 12th Oct 2013
Last edited: 5th Aug 2016
Inclusion in quiz mode: Included

Updating… Please wait.
Loadinganimation

Alert accept

Error Unable to process the form. Check for errors and try again.

Alert accept Thank you for updating your details.