Case 171

 A seventy one-year-old male presented in our hospital for vomiting and abdominal pain from the morning. He had never experienced a surgical management. Abdominal findings indicated slight tenderness in the upper abdomen. Laboratory test revealed creatinine 1.05 mg/dL, CRP 0.86 mg/dL, white blood cells 11730/mm³, neutrocytes 91%. He received abdomen non-enhanced CT which showed ileus with ascites (Fig. 1). Three hours later, he received enhanced CT using contrast medium (Fig. 2) which showed small bowel ileus with no necrosis but with string-like component and increasing ascites. The following morning, abdomen pain was persistent. Then, he received abdomen CT again to judge whether surgical management should be conducted or not (Fig. 3).

What is your imaging diagnosis ?

1.　Adhesive ileus

2.　Para-duodenal Internal ileus

3.　Strangulation ileus

4.　Dietary ileus

5.　Non-occlusive mesenteric ischemia

answer

2019.11.27