PMC7876738_01
Preoperative CT abdominal scan revealed peritoneal free air and abdominal fluid with siero-hematic characteristics (60 UH). After intra-venous contrast administration we identified a perfusion reduction in the inferior pole of the spleen.
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After intra-venous contrast administration we identified a perfusion reduction in the IV hepatic segment and at the inferior pole of the spleen (Fig. 1).
Details of surgical procedure: a-c) laparoscopic exploration with copious amount of hemoperitoneum suggesting active bleeding; d) small bowel with an increasing in wall thickness.
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Treitz ligament in order to identify intestinal perforation. The exploration of the abdominal cavity confirmed copious amount of hemoperitoneum suggesting active bleeding and enteric material due to intestinal perforation (Fig. 2).
a-b) Mesentery presented multiple tearing lesions with active bleeding from disruption of jejunoileal vessels. Hemostasis with bipolar forceps was promptly carried out.; c-d-e-f) meticulous exploration of the small bowel showed five perforation sites.
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At the same time the corresponding mesentery presented multiple tearing lesions with active bleeding from disruption of jejunoileal vessels (Fig. 3).