Season 9 Case 5
Hx: Abdominal pain
Answer: Ischemic Bowel
Fluid filled ?dilated bowel loops? YES
So they all look the same? No
Right abdominal loops (red) = thickened w/o enhancement vs those in the left abdomen (blue) which = early obstruction or ileus.
Surgery=necrotic bowel!
Small Bowel Ischemia
-life threatening EMERGENCY!!
- +wall thickening +/- dilation
-absent enhancement (use other bowel for comparison)
-bowel wall hyperdensity can be due to intramural hemorrhage (can on non-con!) so I look at the mucosa
-pneumatosis = infarction ( for PV gas!)
-CTA helpful to look for arterial etiology (majority)
-Also venous occlusion, systemic hypoTN (shock bowel), trauma, obstruction (ie closed-loop).
-Don't forget this on non-con exams! UGLY segment of bowel + lactate = CALL SURGERY!!
Time = bowel = survival!!