Ischaemic bowel

Case contributed by Dr Bruno Di Muzio

Presentation

Emergency department presentation with acute onset of abdominal pain and distension. History of previous surgery for a pancreatic neoplasia.

Patient Data

Age: 73 years
Gender: Female
CT

CT Abdomen and pelvis

CT demonstrates extensive small bowel dilatation, absent mural enhancement with prominent mural gas seen best in the jejunum. The ascending colon appears thick-walled, up to the proximal transverse colon. Gas is also seen in the branches of the superior mesenteric vein, and peripherally in the liver. A small amount of free peritoneal fluid is present. 

There is evidence of prior pancreatic surgery with a mass seen in the surgical bed, encasing and occluding the superior mesenteric artery. 

Cholecystectomy noted. A normal portal vein cannot be identified; instead a leash of vessels are present at the porta hepatis. 

Annotated image

Extensive small bowel dilatation, absent mural enhancement with prominent mural gas seen best in the jejunum ( * ). The ascending colon appears thick-walled (yellow arrows), up to the proximal transverse colon. Gas is also seen in the branches of the superior mesenteric vein, and peripherally in the liver (green arrows).

There is evidence of prior pancreatic surgery with a mass seen in the surgical bed (red), encasing and occluding the superior mesenteric artery (SMA) and celiac trunk (CT) 

Cavernous transformation of the portal vein (orange). 

Case Discussion

Intramural gas (also known as pneumatosis intestinalis) refers to gas within the wall of the bowel and can be associated with ischaemia and infarction, and usually carries a dismal prognosis. Even if this patient were to survive the acute illness, she would require most of the small bowel resected which leads to enormous morbidity (e.g. short bowel syndrome, requiring total parenteral nutrition etc...). 

PlayAdd to Share

Case information

rID: 13168
Case created: 8th Mar 2011
Last edited: 5th Sep 2015
Inclusion in quiz mode: Included

Updating… Please wait.
Loadinganimation

Alert accept

Error Unable to process the form. Check for errors and try again.

Alert accept Thank you for updating your details.