Ischaemic bowel

Case contributed by Dr Ian Bickle

Presentation

Elderly patient on medical ward with abdominal pain, AF and a metabolic acidosis.

Patient Data

Age: 80 years old
Gender: Female
CT

Multiple loops of small bowel with faeculent type material within.

Dilated non-enhancing small bowel loops in the midline of the lower abdomen/pelvis.

Closed loops obstruction - transition points of afferent and efferent loops - suggesting an adhesional obstruction.

 

 

Annotated image

Three classical signs

1. Closed loop obstruction

2. Small bowel faeces sign

3. Non-enhancing small bowel - with adjacent normally enhancing bowel, illustrating the sign beautifully, indicated ischaemic bowel.

Pathology

The band adhesion is shown underneath the surgical instrument - the cause of the obstruction.

The resultant large length of ischaemic small bowel is shown prior to resection.

Case Discussion

Ischaemic bowel is a relatively frequent presentation to general surgery.

A strong clinical suspicion assists the radiologist in making a confident diagnosis - the signs can be variable and range from subtle to frank.

This case shows a classic example of a closed loop obstruction from a adhesion, with resultant necrotic bowel.

This is evidenced by a long section of non enhancing bowel and the small bowel faeces sign.

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Case information

rID: 29769
Case created: 20th Jun 2014
Last edited: 30th May 2017
Inclusion in quiz mode: Included

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