Presentation
Acute abdominal pain. Ischemic gut?
Patient Data
Constriction of the ileum in the left iliac fossa at two nearby points (proximal, distal coronal) with dilatation of the obstructed loop as well as the proximal ileum.
Congested mesentery related to the closed loop but well-perfused bowel wall and opacified mesenteric veins.
Fluid content of the obstructed ileum is similar attenuation to water. No evidence of intraluminal hemorrhage.
Minor ascites of abdomen and pelvis.
No evidence of pneumatosis or perforation.
Case Discussion
In this case, the ileum within the closed loop is more dilated than the proximal ileum.
Lymphatic and venous constriction at the neck is causing mesenteric venous congestion and edema.
Bowel wall enhancement corresponds with an intact arterial supply.
There was no mural or intraluminal hemorrhage on non-contrast CT (not shown) and subtraction CT and iodine maps (not shown) did not contribute to the diagnosis in this case.
Laparoscopic adhesiolysis was performed which resolved his symptoms and he was discharged home the following day.
In this case the closed loop is easily identified due to the mesenteric congestion. The axial reformats show the nearby transition points with fatty indentation at the adhesion (double beak sign).
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