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Multimodality Diagnosis of Mesenteric Ischemia
Published on: July 21, 2023
A case of small bowel mesenteric pneumatosis: A multidisciplinary approach to clinical interpretation and
Christopher Johnstone1, Tamir Salih2, Arin Saha2
1St. James Hospital, Leeds, United Kingdom.
Introduction:
Pneumatosis of the small bowel mesentery is rare and the preserve of case reports. This case report describes the importance of a multi-disciplinary team (MDT) approach to rare pathologies.
Case Report:
A 78-year-old man presented to our unit with a two-day history of upper abdominal pain associated with nausea and intermittent vomiting. An urgent computed tomography (CT) scan was organised. The scan was grossly abnormal and difficult to interpret; it was reported as widespread intra-mural gas within the small bowel wall most likely secondary to extensive small bowel ischaemia. Although surgical intervention was very high risk (predicted P-possum mortality of over 60%) and there was a strong possibility that the patient would not recover from surgery, the disparity between clinical and radiological findings meant that a diagnostic laparoscopy was indicated. A diagnostic laparoscopy showed that the small bowel itself was normal but there was extensive gas within the mesentery, caused by a band adhesion which had eroded into the peritoneal layer of the small bowel mesentery.
Discussion:
Pneumatosis of the small bowel mesentery is a pathological sign rather than a diagnosis and is characterised by gas within the mesenteric sleeves. It is likely associated with significant morbidity and therefore rarely observed as the majority with this sign would not be deemed suitable for surgical intervention.
Conclusion:
The case highlights an unusual pathology, rare imaging findings, the importance of a multi-disciplinary approach and the value of clear communication and informed consent when considering major intervention or surgery.
Insights
Pneumatosis of the small bowel mesentery, a rare condition, was diagnosed in a patient presenting with abdominal pain. A multi-disciplinary team approach was crucial for managing this unusual pathology and its imaging findings.
Area of Science:
- Gastroenterology
- Surgical Pathology
Background:
- Pneumatosis of the small bowel mesentery is an uncommon condition, typically documented in case reports.
- This case report emphasizes the significance of a multi-disciplinary team (MDT) approach for managing rare pathologies.
Purpose of the Study:
- To report a rare case of pneumatosis of the small bowel mesentery.
- To highlight the importance of a multi-disciplinary team approach in managing rare gastrointestinal pathologies.
Main Methods:
- A 78-year-old male presented with acute upper abdominal pain, nausea, and vomiting.
- Computed tomography (CT) scan revealed widespread intra-mural gas, suspected to be small bowel ischemia.
- Diagnostic laparoscopy was performed due to discrepancies between clinical and radiological findings, revealing mesenteric gas from a band adhesion.
Main Results:
- The small bowel appeared normal during laparoscopy.
- Extensive gas was found within the mesentery, attributed to a band adhesion eroding into the mesenteric peritoneal layer.
- Pneumatosis of the small bowel mesentery is a sign characterized by gas in mesenteric sleeves, often associated with significant morbidity.
Conclusions:
- Pneumatosis of the small bowel mesentery is a pathological sign, not a diagnosis.
- The case underscores the value of a multi-disciplinary approach, clear communication, and informed consent in managing rare conditions requiring major intervention.
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