Age: 72
Sex: Male
Indication: Concern for bowel obstruction (no surgical history available)
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Case #82
Findings
- Lower chest
- No acute findings
- Abdomen/Pelvis
- Swirling of the small bowel mesentery with occlusion of the SMV
- Surgical changes of cholecystectomy and hepaticojejunostomy with proximal side-to-side anastomosis and swirling of the efferent bowel loop and associated mesentery just proximal to the distal anastomosis
- Edema throughout the central small bowel mesentery with scattered mildly enlarged mesenteric lymph nodes
- No pronounced segmental bowel wall thickening, pneumatosis, or portal venous gas
- No bowel obstruction
- No free air or loculated intraabdominal fluid collection
- Enhancing right lower pole renal mass measuring up to 1.8 cm
- Indeterminate ill-defined hypoattenuating areas in the left kidney
- Scattered calcified granulomas in the spleen
- Colonic diverticulosis
- Circumferential mural thickening of the urinary bladder
- Prostatomegaly
- Bilateral hydroceles, partially imaged
- Heavy atherosclerotic calcification of the abdominal aorta and branch vessels without aneurysm
- MSK
- No acute findings
- L2 superior endplate Schmorl’s node
- Small fat-containing left inguinal hernia and umbilical hernia
Diagnosis
Midgut volvulus
Sample Report
Findings concerning for midgut volvulus with resultant occlusion of the SMV and extensive mesenteric edema. No convincing pneumatosis or evidence of perforation. Recommend surgical consultation.
Surgical changes of cholecystectomy and hepaticojejunostomy with swirling of the efferent bowel loop and associated mesentery just proximal to the distal anastomosis. This finding raises the possibility of an internal hernia, though this patient’s expected postoperative anatomy is unclear in the absence of prior comparison studies. No evidence of bowel obstruction.
Enhancing mass arising from the lower pole of the right kidney is concerning for renal cell carcinoma. Additional ill-defined hypoattenuating left renal lesions are indeterminate. Outpatient renal protocol MRI should be considered for further assessment.
Discussion
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References
- Dhatt HS, Behr SC, Miracle A, Wang ZJ, Yeh BM. Radiological Evaluation of Bowel Ischemia. Radiol Clin North Am 2015; 53(6): 1241-1254.
- Doishita S, Takeshita T, Uchima Y, Kawasaki M, Shimono T, Yamashita A, Sugimoto M, Ninoi T, Shima H, Miki Y. Internal hernias in the era of multidetector CT: correlation of imaging and surgical findings. Radiographics 2016; 36(1): 88-106.
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