Presentation
Abdominal pain.
Patient Data
Cirrhosis. Medium volume ascites. Thrombosis of right lower quadrant ileal branches of the superior mesenteric vein. Segmental thickening, hypoenhancement, and increased focal mesenteric edema/congestion of a long segment of ileum within this distribution (note increased edema surrounding vascular arcades/vasa recta).
Case Discussion
This is a challenging case as it can be easy to overlook or misattribute the right lower quadrant small bowel ischemia due to the underlying ascites, perhaps thinking it is related to infection, inflammation or portal hypertensive enteropathy. Notice how there is increased congestion and edema surrounding the arcades/vasa recta supplying this segment, which is a typical finding of venous ischemia due to SMV thrombosis. It is essential to run the venous vasculature in every CT abdomen/pelvis case, and use these secondary findings to increase your suspicion and direct your search pattern. This patient was managed with systemic anticoagulation.
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