PMC9537035_01
Pre- and postoperative abdominal CT scan. (a) Dilation of multiple small bowel and colon loops, consistent with ileus. Development of right colonic pneumatosis and multiple locules of free intraperitoneal air concerning of underlying perforation. (b) Interval decrease in subcutaneous fluid collection underlying the incision. No evidence for intraperitoneal or abdominal wall fluid collections. Stable to mildly increased stranding in the mesentery underlying the stoma may represent postoperative changes or developing fat necrosis.
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fig1
In discontinuity with the rest of the small bowel, other portion of the end terminal ileum was exteriorized as a mucous fistula (Figure 1).
Timeline of intervention and outcomes. Admissions and discharge dates to the B&M hospital and the ACH program in Mayo Clinic Florida, created with BioRender.
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Pain medication polypharmacy (oxycodone and fentanyl patch) was the attributed cause of the mental status change, and once it was determined, no further imaging or invasive procedures were necessary; she was transported back home with ACH on January 19, 2022 (Figure 2).
Postoperative abdominal X-ray. Bowel gas pattern is nonobstructive and postsurgical changes from spinal fusion.
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A postsurgical abdominal X-ray image was done with evidence of nonobstructive pattern as shown in Figure 3.