Presentation
Abdominal pain.
Patient Data
Cirrhosis. Dilated GB with stone. Subtotal colectomy. Diffusely dilated small bowel with a targetoid appearance of much of the small bowel, but with overall diminished enhancement. Mesenteric edema with small ascites. Thrombosis of SMV, splenic vein, portal vein and intrahepatic branches.
TIPS. Small bowel perforation with peritonitis and ascites. Right lower quadrant pigtail catheter. Small bowel pneumatosis in the pelvis with extraluminal air/fluid/enteric contents.
Case Discussion
The patient had a recent history of subtotal colectomy for Crohn disease and presented with abdominal pain and thrombosis of SMV, PV, and splenic vein with small bowel ischemia.
Note the small bowel thickening with the targetoid appearance which can be seen with either venous ischemia (elevated venous pressures/preserved arterial inflow) or arterial ischemia after reperfusion (reperfusion injury). The patient was treated with anticoagulation and TIPS, but unfortunately developed worsening pain and had purulent ascites discovered after an abdominal drain was placed, and underwent a repeated CT showing pneumatosis and perforation of small bowel due to ischemia.
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