PMC3712003_01
CT of abdomen and pelvis with contrast demonstrating a small area of fat stranding in anterior midline of lower abdomen and adjacent small bowel wall thickening.. Note: The small linear density contained within the area of inflammation (yellow circle).
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Contrast computed tomography (CT) of the abdomen and pelvis showed a small area of fat stranding in anterior midline of lower abdomen and adjacent small bowel wall thickening (Fig. 1).
Repeat CT of the abdomen 5 weeks after initial presentation showing a radiopaque linear structure crossing to the left pelvis with surrounding inflammatory changes (yellow circle).
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Repeat abdominal CT showed a 5.5 cm extraluminal fluid collection in the mid abdomen adjacent to a loop of ileum with a radiopaque linear structure thought to be oral contrast crossing into the left pelvis with surrounding inflammatory changes (Fig. 2).
Images of terminal ileum during colonoscopic evaluation.
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Colonoscopy including endoscopic assessment of the terminal ileal mucosa was normal (Fig. 3).
Repeat CT of the abdomen and pelvis one and a half months after initial presentation with improvement in extraluminal inflammation.. Note: The linear density persists (yellow circle).
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Repeat CT showing improvement of the extraluminal fluid collections (Fig. 4).
PMC3712003_02
Resected small bowel with perforating blue toothpick (stitch marks the area of perforation).
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Fifteen cm of ileum was resected encompassing the area of toothpick perforation (Fig. 5).