Presentation
Upper abdominal pain in a 32-week pregnant woman.
Patient Data
Large amount of free fluid in left paracolic gutter and between intestinal loops.
Aperistaltic, dilated intestinal loops in left abdomen, mainly in upper quadrant, with markedly thickened walls (up to 1.6 cm thick) exhibiting stratified appearance. No blood flow demonstrated in intesinal walls.
Arterial phase (not shown) and late venous phase CT:
Gravid uterus, advanced pregnancy.
In left abdomen, there is a small bowel loop containing a small bowel loop and mesentery which shows mild fat stranding. Bowel wall in said loops is markedly thickened. Proximal to intussuscept, jejunum and stomach are dilated and filled with contrast material. Fluid in left paracolic gutter.
Case Discussion
The woman was rushed to the OR for exploratory laparotomy. The surgical report was as follows: "Intussusception of a long segment of jejunum, at least 50 cm in length. Following its release, an ischemic segment was revealed with a hemorrhagic wall and abscence of pulse. In addition, a large 3-cm polyp was palpated in the proximal bowel. Moderate amount of serotic fluid in the abdominal cavity. Proximal small bowel markedly dilated, up to 5-6 cm. [...] 70 cm of jejunum excised. End-to-end anastomosis. [...] Small incision over jejunal polyp and excision of polyp with long stalk."
As bowel ischemia requires emergent surgery, abdominal CT can be justified in pregnancy. Of note, the hospital did not have an MRI machine at the time.
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