Presentation
Abdominal discomfort.
Patient Data
Segemental dilation of right lower quadrant small bowel loops with tethering and fecalization. Some associated mesenteric edema. Just beyond the transition point, there is mildly thickened distal ileum is tethered/radially oriented around a cluster of abnormal RLQ lymph nodes. Lower abdominal/pelvic herniorraphy.
Case Discussion
Following right hemicolectomy with suspicion of mass, the final pathology showed:
Neuroendocrine tumor of small intestine (ileum) with invasion into perienteric adipose tissue; two perienteric/mesenteric tumor deposits
This case highlights the value of carefully evaluating the images on both axial and coronal images. I find the cause of obstruction quite difficult to sort out on axial, but the relationship to the mesenteric deposits with tethering desmoplastic reaction much more apparent with coronal reformats. The presence of herniorrhaphy is misleading and might make your first reaction to think of simple adhesive disease with partial small bowel obstruction.
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