Ischemic small bowel

No evidence of perforation or obstruction. Solitary loop of small bowel in the right iliac fossa. No subdiaphragmatic free gas. Features of chronic airway disease.

Scanned after symptoms worsened & blood results returned.

Grossly abnormal small bowel. The distal jejunum and majority of the ileum are dilated, fluid-filled and hypo-enhancing.

No free intraperitoneal gas. Free fluid which is predominately right-sided and peri-hepatic.

Normal cecum and large bowel. The stomach and duodenum are markedly dilated but enhance normally. Small hiatus hernia.

Gas within the portal vein at the SMV/splenic vein confluence extra-vascular gas tracking anterior to the SMV within the mesentery. Multifocal linear gas lucencies peripherally within the liver represent portal venous gas.

Both kidneys are small: normal enhancement on the left, but multifocal areas of reduced enhancement on the right consistent with ischemia/infarction.

Hypodense mass within the right adrenal measures 2.5 x 1 .5 cm; it may be an adrenal adenoma, but has not been fully characterized on this study.

Hysterectomy and bilateral salpingo-oophorectomy.

CONCLUSION :

1. Two large segments of ischemic small bowel (jejunum and a large proportion of ileum). Small-volume jejunal mural gas with mesenteric and portal venous gas, but no perforation. Heavily calcified mesenteric vessels make thromboembolic disease the most likely cause.

2. Small bowel dilatation (with stomach and duodenal dilatation); no mechanical cause. NG tube would be helpful to decompress the stomach.

3. Significant intra-vascular fluid depletion; right renal parenchymal ischemia may be acute.