Presentation
RUQ and right flank pain.
Patient Data
Thickwalled loops of ileum that are hypoenhancing. The cecum and ascending colon to the level of the hepatic flexure is also mildly thickwalled and hypoenhancing. Associated mild mesenteric fat stranding.
Filling defect within the mid SMA, just distal to the origin of the jejunal branches. There is also filling defect within the superior mesenteric vein. Portal vein is patent. No portal venous gas and no areas of mural gas within the affected small and large bowel.
Liver has a slightly mottled appearance. Wedge-shaped peripheral hypodensity within the spleen may be an infarct.
Case Discussion
Ischemic gut, especially in the elderly, has a very poor prognosis with a high mortality. Common causes include SMA thrombus or embolus (e.g. from AF).
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