PMC4891627_01
Contrast enhanced CT scan of the abdomen/pelvis in the axial plane showing thickened bowel (arrows) and mesenteric congestion (arrowhead). The contrast progressed distally. [Powerpoint Slide]
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A computed tomography (CT) scan (Figure 1) was obtained which revealed a focal loop of thickened bowel alongside mild vascular congestion.
Single anteroposterior abdominal radiograph showing markedly dilated small bowel. [Powerpoint Slide]
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An abdominal x-ray (Figure 2) was obtained which showed markedly dilated bowel loops indicative of a bowel obstruction.
Coronal reformatted, contrast enhanced CT images of the abdomen/pelvis revealing thickened small bowel (arrows), induration and vascular congestion (arrowheads) seen along the adjacent mesentery with fat stranding, and dilated bowel. [Powerpoint Slide]
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This was followed by a CT scan (Figure 3) which depicted acute small bowel obstruction alongside mesenteric congestion and inflammation coupled with bowel wall enhancement and thickening, suggestive of bowel ischemia, acute infection and/or an acute inflammatory process.
Gross image depicting the defect found in the mesentery where bowel had herniated through (arrow). [Powerpoint Slide]
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A 3 cm mesenteric tear had been created where the patient had subsequently developed an internal hernia (Figure 4).
Internal hernia contents consisting of both bowel and omentum (arrow). [Powerpoint Slide]
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Loops of small bowel and omentum had herniated through the defect with a single piece of omentum that had become compromised, compounding the small bowel obstruction (Figure 5).