Presentation
Two days history of suprapubic pain, twisting in nature associated with vomitting
Patient Data
CT shows short segment thin non enhancing wall approximately 7.4 cm in length in the mid ileum with proximal small bowel dilatation. No evidence of mesenteric artery and venous thrombosis. The rest of small bowel are normally enhanced with slightly thickened. No intramural air. Aortic mural thrombus at descending thoracic aorta and abdominal aorta.
Case Discussion
Intraoperative findings show ischemia of the ileum starting 10 cm from ileo-cecal junction extending to about 60 cm. Segments of this small bowel are paper thin in keeping with pending perforation. The rest of small bowel proximal to this segment of ischemic bowel is dilated and edematous all the way to duodenojejunal flexure. No twisting of mesentery. Limited right hemicolectomy with double barrel stoma was performed.
No identifiable cause of bowel ischemia in this patient, however, there is intramural thrombosis of the descending thoracic aorta with atherosclerotic changes of the abdominal aorta, which lead to the suspicion of an embolic event.