Presentation
Diffuse abdominal pain, repeated vomiting and absolute constipation of 10 days duration. Past history of rheumatic valvular disease and AF. She had a tachycardic pulse with AF. Echo: Moderate MR, severe AS and AR. Erect AXR: Multiple gas-fluid levels suggestive of intestinal obstruction. Abdominal ultrasound: Multiple dilated bowel loops with decreased wall thickness, no peristalsis, with to-and-fro movement of its contents. Mild free fluid. Unfortunately, she died two days later.
Patient Data
Complete occlusion of the superior mesenteric artery by an embolus, just below its origin suggesting mesenteric vascular occlusion with failure of contrast passage distally.
Dilated small bowel loops with decreased wall thickness (paper-thin wall), no wall enhancement and multiple gas-fluid levels. Multiple gas foci are seen within the wall of dilated small bowel loops indicating pneumatosis intestinalis.
Collapsed IVC.
Mild free fluid.
Case Discussion
Mesenteric vascular occlusion is a life-threatening disease with high morbidity and mortality. It is caused by different conditions such as arterial occlusion, venous occlusion, strangulating obstruction, and hypoperfusion associated with non-occlusive vascular disease.
CT findings vary widely depending on the cause and underlying pathophysiology. Conventional angiography was the modality of choice for such cases in the past, but now MDCT is first-line. Conventional angiography is reserved for interventional procedures.
Accurate diagnosis helps in proper management of patients with acute mesenteric occlusion improving their prognosis.
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