PMC10017220_01
Serial scout film of the abdomen. Description: regression of ileus; there is a decrease in number and amount of air-filled small bowel segments with no organizing pattern.
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Serial scout film of the abdomen (SFA) revealed only the presence of ileus with no evidence of pneumoperitoneum (Figure 1).
Whole abdominal CT scan with contrast. Description: large bowel obstruction with transition point at the rectosigmoid junction, likely from postoperative adhesions; pneumatosis coli in the cecum and ascending colon; no ascites, pneumoperitoneum, or enlarged lymph nodes; prominent-sized appendix without inflammatory changes; and anteverted and globularly enlarged uterus with a prominent endometrium.
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Hence, A whole abdominal computed tomography (CT) scan with contrast (Figure 2) was requested which revealed large bowel obstruction.
Scout film of the abdomen. Follow-up study to the previous scout film of the abdomen, now demonstrates extensive amount of free intraperitoneal air as pointed by the blue arrows with lucency in the subdiaphragmatic area as pointed by the red arrow. Description: interval demonstration of extensive amount of pneumoperitoneum with scanty to absent colonic gas in the present study; regression of the ileus; gastric distention.
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A scout film of the abdomen (Figure 3) was requested and revealed extensive amount of free intraperitoneal air (as pointed by the blue arrows) with lucency in the subdiaphragmatic area (as pointed by the red arrow).
Gross specimen. Description: upon opening the peritoneum, free air was evacuated. Approximately 1.4 L of fecaloid peritoneal fluid was suctioned. Adhesive band noted at the pelvic area. Noted a 2 cm full thickness perforation at the cecum. 17 cm serosal tear from the cecum to ascending colon. Bowel loops proximal to the perforation were dilated.
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Specimen (terminal ileum to proximal transverse colon) was sent for histopathology (Figure 4) which revealed acute inflammatory cells infiltrating the blood vessels and possible microthrombi and beginning thrombus formation were noted in the subserosa.