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!!