SMA thrombosis, fecalization, and perforation

Case contributed by Dr Michael P Hartung

Presentation

Abdominal pain.

Patient Data

Age: 65 years
Gender: Female

Small bowel is massively dilated, thick-walled, and filled with fecalized material. 

Ill-defined transition point in the pelvis with heterogeneous enhancement. 

Small amount of free intraperitoneal air. 

SMA is thrombosed proximally with minimal distal reconstitution of a few branches, likely via IMA collaterals. Celiac origin is narrowed due to median arcuate ligament impression. 

Poor filling of SMV. 

Heteregenous perfusion of the liver and spleen. 

Case Discussion

Dramatic case of a late presentation of mesenteric ischemia, obstruction, and perforation. 

The SMA thrombosis does not appear acute given the relatively small caliber, and may well be a chronic finding. A possible course of events could be (1) chronic mesenteric ischemia (2) developing small bowel obstruction (3) progressively worsening ischemia resulting in stasis and fecalization (4) perforation. 

Unfortunately, I am not able to determine the cause of obstruction/abnormal enhancement in the pelvis. 

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Case information

rID: 68824
Published: 18th Jun 2019
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included
Institution: Tenwek Hospital

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