SMA thrombosis, fecalization, and perforation
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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.
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.