Distal intestinal obstruction syndrome and cirrhosis

Case contributed by Dr Natalie Yang

Presentation

abdominal pain and vomiting. known case of cystic fibrosis.

Patient Data

Age: 25 years

The liver has nodular surface and atrophic, in keeping with cirrhosis. Dilated paraumbilical vein and large number of varices around the distal esophagus, splenorenal, as well as splenic hilam, features of portal hypertension. Splenomegally is also seen. 

The small bowel loops are distended, with small bowel faeces signs seen in the distal ileum, leading to a transition point, from there the distal and terminal ielum are collapsed. No enhancing mass can be seen. No abnormal bowel wall thickening or hypoenhancment seen. 

Pancreas is atrophic with fatty relacement, in keeping with the known history of cystic fibrosis. 

Portal vein as well as splenic and SMV appear patent. 

Minimal ascetic free fluid. 

Interpretation: 1. acute small bowel obstruction, with transition point in the distal ileum (distal intestinal obstruction syndrome). 2. Features of cirrhosis and portal hypertension.

Case Discussion

CT of the abdomen of a 25 year old patient with known cystic fibrosis (CF) presents with distal intestinal obstruction syndrome

The liver is markedly nodular in contour in keeping with advanced cirrhosis and extensive dilated portosystemic collaterals are seen, consistent with  portal hypertension. The spleen is also markedly enlarged. Also note the complete fatty atrophy of the pancreas - a feature of cystic fibrosis.

The small bowel is dilated and fluid filled bowel all the way to the distal ileum.

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Case information

rID: 6943
Case created: 30th Aug 2009
Last edited: 23rd Sep 2016
Inclusion in quiz mode: Included

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