Season 9 Case 5

Season 9 Aug 28, 2020

Hx: Abdominal pain

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!

-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!!