Presentation
6 days history of not opening bowels, intermittent vomiting, feeling generally unwell, has been passing wind. O/E lower abdominal tenderness HR 110, lactate 12 on gas PH-7.15 - ?intraabdominal bleed, ?perforation
Patient Data
No pneumoperitoneum. No intra-abdominal bleed.
There is evidence of acute small intestinal obstruction, due to acute small bowel ischemia at proximal ileal / distal jejunal level, showing reduced wall enhancement, intramural gas, resulting in upstream dilatation of proximal loops including stomach and esophagus.
Significant circumferential wall calcification and narrowing of superior mesenteric artery origin is noted.
There is evidence of free air foci in the root of mesentery. No portal venous gas.
Mild ascites.
Uncomplicated large right inguinal hernia containing small bowel loops is noted.
Case Discussion
Mesenteric ischemia is a surgical emergency.
The patient underwent immediate surgery, resection of ischemic segment and interval anastomosis.
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