Eighty-year-old woman with acute abdominal pain.
Which choice best characterizes the salient finding(s)?
After an emergent laparotomy and arteriotomy with SMA thrombectomy, a CTA chest/abdomen/pelvis was performed which demonstrates the re-perfused small bowel.
The next set of images (same patient) was taken 3 days later after an acute drop in hemoglobin. Click to enlarge.
Initial CT (First 3 images above): There is an acute occlusive thrombus in the superior mesenteric artery with non-enhancing bowel wall throughout the jejunum and proximal ileum. No signs of bowel infarction or perforation.
CT four days later (4th image above) following laparotomy and arteriotomy with SMA thrombectomy: Interval resolution of SMA occlusion with reperfusion and normal bowel wall enhancement of the jejunum and ileum.
Findings (rescanned after acute hemoglobin drop):
Small to moderate amount of hemoperitoneum with an enhancing vessel terminating in a ventral intraperitoneal fluid collection which displays a hematocrit level, likely representing active extravasation.
Differential diagnosis: For acute mesenteric ischemia:
Informational and key points: