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CT manifestations of small bowel ischemia due to impaired venous drainage-with a correlation of pathologic findings

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ABSTRACT

Acute abdominal pain may result from a wide variety of medical and surgical diseases. One of these diseases is small bowel ischemia, which may result in a catastrophic outcome if not recognized and treated promptly. Computed tomography (CT) by its faster image acquisition, thinner collimation, high resolution, and multiplanar reformatted images has become the most important imaging modality in evaluating the acute abdominal conditions. In this article, the author presents a description of the histology of the small bowel, pathophysiology of small bowel change, and a correlation of the pathologic and CT findings of the small bowel injuries due to impaired venous drainage. A convincing correlation of the microscopic mucosal condition with the enhancement pattern of the thickened small bowel wall on CT is useful in definitely describing the mucosal viability.

No MeSH data available.


Related in: MedlinePlus

A 32-year-old woman with an adhesion-induced internal hernia. (A–F) Contrast-enhanced skipped, nonadjacent images. The circumscribed segment is totally filled with fluid and can be successfully traced from one end (1) to the other (18). Both ends are in close contact. The wall is approximately 2.75–3.75 mm thick. It is poorly enhancing and darker than the muscles. The patient received small-bowel resection and recovered. The specimen showed hemorrhagic necrosis of the full thickness of the wall
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Figure 10: A 32-year-old woman with an adhesion-induced internal hernia. (A–F) Contrast-enhanced skipped, nonadjacent images. The circumscribed segment is totally filled with fluid and can be successfully traced from one end (1) to the other (18). Both ends are in close contact. The wall is approximately 2.75–3.75 mm thick. It is poorly enhancing and darker than the muscles. The patient received small-bowel resection and recovered. The specimen showed hemorrhagic necrosis of the full thickness of the wall

Mentions: In closed-loop small-bowel obstruction, volvulus results in the typical whirl of the superior mesenteric vessels and associated bowel. An internal hernia through a congenital or acquired foramen of the mesentery or ligaments may be recognized because of the special course of the splanchnic vessels[30313233] or the unusual locations of bowel loops.[3233] Common appearances of closed-loop obstruction due to any cause include a circumscribed or U-shaped configuration of distended loops that are nearly completely filled with fluid [Figure 10]. Another common appearance is a radial distribution of fluid-filled dilated loops with convergence of the associated stretched and engorged vessels (spoke-wheel sign).[34] Images may also depict fusiform tapering (beak sign) of the two ends of the dilated loop [Figure 11], a triangular shape of the ends of the bowel, or two collapsed adjacent loops.[3536]


CT manifestations of small bowel ischemia due to impaired venous drainage-with a correlation of pathologic findings
A 32-year-old woman with an adhesion-induced internal hernia. (A–F) Contrast-enhanced skipped, nonadjacent images. The circumscribed segment is totally filled with fluid and can be successfully traced from one end (1) to the other (18). Both ends are in close contact. The wall is approximately 2.75–3.75 mm thick. It is poorly enhancing and darker than the muscles. The patient received small-bowel resection and recovered. The specimen showed hemorrhagic necrosis of the full thickness of the wall
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5036332&req=5

Figure 10: A 32-year-old woman with an adhesion-induced internal hernia. (A–F) Contrast-enhanced skipped, nonadjacent images. The circumscribed segment is totally filled with fluid and can be successfully traced from one end (1) to the other (18). Both ends are in close contact. The wall is approximately 2.75–3.75 mm thick. It is poorly enhancing and darker than the muscles. The patient received small-bowel resection and recovered. The specimen showed hemorrhagic necrosis of the full thickness of the wall
Mentions: In closed-loop small-bowel obstruction, volvulus results in the typical whirl of the superior mesenteric vessels and associated bowel. An internal hernia through a congenital or acquired foramen of the mesentery or ligaments may be recognized because of the special course of the splanchnic vessels[30313233] or the unusual locations of bowel loops.[3233] Common appearances of closed-loop obstruction due to any cause include a circumscribed or U-shaped configuration of distended loops that are nearly completely filled with fluid [Figure 10]. Another common appearance is a radial distribution of fluid-filled dilated loops with convergence of the associated stretched and engorged vessels (spoke-wheel sign).[34] Images may also depict fusiform tapering (beak sign) of the two ends of the dilated loop [Figure 11], a triangular shape of the ends of the bowel, or two collapsed adjacent loops.[3536]

View Article: PubMed Central - PubMed

ABSTRACT

Acute abdominal pain may result from a wide variety of medical and surgical diseases. One of these diseases is small bowel ischemia, which may result in a catastrophic outcome if not recognized and treated promptly. Computed tomography (CT) by its faster image acquisition, thinner collimation, high resolution, and multiplanar reformatted images has become the most important imaging modality in evaluating the acute abdominal conditions. In this article, the author presents a description of the histology of the small bowel, pathophysiology of small bowel change, and a correlation of the pathologic and CT findings of the small bowel injuries due to impaired venous drainage. A convincing correlation of the microscopic mucosal condition with the enhancement pattern of the thickened small bowel wall on CT is useful in definitely describing the mucosal viability.

No MeSH data available.


Related in: MedlinePlus