Ischemic bowel due to internal hernia with perforation

A large amount of intra-abdominal free fluid and gas indicates a perforated hollow viscus. The majority of the free gas is in the upper right side of the abdomen.

Loops of small bowel in the right side of the abdomen are moderately distended adjacent and anterior to the ascending colon and cecum. These loops show markedly reduced mural enhancement (best on the low monoE reconstruction) which is concerning for bowel ischemia. The SMA, SMV and portal vein are patent. The SMA branches supplying this region are poorly opacified. Given the distribution of affected bowel loops, an internal hernia is suspected.

Indwelling catheter within the bladder. The liver, spleen, adrenals, pancreas, and kidneys have unremarkable appearances. Small direct inguinal hernias are noted bilaterally.

Mild bilateral pleural effusions with dependent atelectasis.

Chronic-appearing endplate compression injury and Schmorl's nodes are noted throughout the lumbar spine. No acute appearing fracture or concerning bone lesion detected. A few old rib fractures are noted anteriorly on the right.

Impression

Evidence of perforated hollow viscus, with the likely source being ischemic appearing bowel loops in the anterior right abdomen. The underlying cause is unclear, with internal hernia a possibility (trans mesenteric).