Presentation
Mild constant abdominal pain. Altered bowel habits - constipation and diarrhoea.
Patient Data
- large perforation identified at the proximal jejunum
- walled-off collection identified posterior to the jejunum, measuring 50 x 30 mm in the maximal axial dimension
- large amount of extraluminal free gas identified in the left paramedian abdomen, adjacent to the bowel loops; further frank free gas locules are identified in the perihepatic and left upper quadrant region
- multiple small bowel diverticula seen
- inflammatory phlegmon of the ileum
Other findings on the scan which are chronic for this patient:
- small hiatus hernia
- a partially exophytic renal lesion is identified in the apical pole of the left kidney
- hypoechoic lesion with adjacent enhancement ? haemangioma located in hepatic segment 8
- pancreas is atrophic
- ill-defined, non-specific hypodensity is identified in the spleen - the spleen is otherwise normal on CT
- large perforation identified at the proximal jejunum (Key Image 1)
- there is a walled-off collection identified posterior to the jejunum, measuring 50 x 30 mm in maximal axial dimension (Key Image 2)
- there is a large amount of extraluminal free gas identified in the left paramedian abdomen, adjacent to the bowel loops (Key Image 3)
Case Discussion
This is an elderly patient with a recent history of terminal ileum inflammation and diverticulitis. She was also in the process of having investigations and workup for the incidental findings of splenic, hepatic, and renal lesions. She had this scan to investigate any interval changes due to ongoing mild abdominal pain and altered bowel habits.
She was admitted to the general surgery team for a few days for conservative management because of her age and other co-morbidities. She was treated with intravenous antibiotics and had daily blood investigations to monitor her inflammatory markers.
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