Acute bowel ischemia
Sudden onset pain in abdomen
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· 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.
Affects small or large bowel, diffuse or focal
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