Presentation
On asparginase therapy for ALL. Sudden onset abdominal pain. Tender across upper and mid abdomen.
Patient Data
Low attenuation of the liver due to intense fat infiltration. Wedge-shaped peripheral low attenuation areas in spleen in keeping with infarcts. 5 cm long segment fo jejunum with mild mural thickening and poor enhancement. Fat-containing paraumbilical hernia.
Rpt CT 3 days later due to...
Rpt CT 3 days later due to sudden clinical detrioration
There is now a pneumoperitoneum, with the source being the previously detected ischemic jejunal loop which has now infarcted. There is gas in the bowel wall and in the adjacent fat, with inflammation of the fat extending to the greater omentum. The splenic infarcts are now more obvious.
Case Discussion
The cause of the bowel and spleen ischemia and infarcts was thought to be the asparaginase therapy for the underlying ALL, although intrinsic coagulation disorders in hematological diseases can also lead to such events.
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