Presentation
Suspected acute bowel obstruction.
Patient Data
Tense, dilated, short ileal C-loop indenting the liver with thin, mildly hypoenhancing wall, minor fat-stranding and minor free fluid. Angular, narrowed limbs of the 'C' at the point of obstruction outlined by fat, giving rise to a ‘beak’ appearance.
Proximal small bowel dilatation.
Case Discussion
Pathology report:
Clinical Information: Laparotomy + adhesiolysis + small bowel resection (closed loop)
DIAGNOSTIC SUMMARY: Small bowel resection: Small bowel infarct.
Macroscopic Description: Labeled "small bowel resection", the specimen consists of a segment of small bowel 80mm in length and 34mm in diameter. The margins are inked blue and staples removed. The serosa is dusky over the central portion of the specimen and is of normal color at the margins. The serosal surface centrally has areas of adherent fibrin. The mucosa at the margins is of normal color. The mucosa centrally is dusky with fibrinous exudate. Block 1A- one margin into dusky mucosa; 1B- other margin into dusky mucosa; 1C- dusky mucosa with fibrinous exudate; 1D- shave of mesentery with vessels. AV Microscopic Description: Small bowel resection. Sections show small bowel in which there is marked fresh hemorrhage, interstitial edema and vascular ectasis. In addition, there is a small segment of small bowel showing mucosa necrosis with mucosal ulceration. No tumor is seen. Both resection margins are unremarkable.
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