Presentation
Initially presented with anemia and a lower GI bleed. Underwent tumor debulking with Hartmann's procedure and a left colostomy. Re-presents with more abdominal pain, querying bowel obstruction or colitis.
Patient Data
Diffuse peritoneal thickening which measures up to 60 mm in thickness in the axial plane adjacent to the left kidney (previously 52 mm) with a markedly thickened and nodular subdiaphragmatic peritoneum. There are multiple pockets of intraperitoneal free fluid, the largest in the perihepatic space, which is similar in size and configuration compared to the prior study.
There are small bowel loops in the upper abdomen centrally at the upper limit of normal measuring 2.9 cm. Other bowel loops are of normal caliber. No pneumatosis or portal venous gas.
No evidence of bowel obstruction, ischemia, or perforation. Colitis cannot be excluded due to the burden of disease and longstanding bowel wall thickening that is pre-existing.
The patient underwent maximal tumor debulking, Hartmann's procedure and end colostomy formation. Diagnosis was confirmed via surgical histopathology.
Case Discussion
A 30-year-old male presents to the ED with abdominal pain and has a known history of malignant peritoneal mesothelioma. He recently presented similarly and was found to have a small bowel obstruction. A CT scan was requested to further evaluate.
Note the diffuse peritoneal thickening throughout the imaged abdomen and, in particular, the diaphragmatic thickening on the sagittal view. Widespread ascites and paucity of intra-abdominal fat limit the assessment of the bowel wall thickness and mesentery; however, the gas pattern demonstrates normal bowel size. There is no evidence of small bowel obstruction or colitis on this study.
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