28/01/2026
Acase of 43 y old male came to my clinic complaining of acute abdominal pain associated with bloody stool
On exam
B.p=110/70
Pulse is irregular
Chest and heart are free
Abdomoninal exam revealed diffuse abdominal tenderness
Ecg showed rapid A.F
U/S showed calcular cholecystitis
Diagnosis is
1_Liver cirrhosis
2_ cacular cholecystitis
3_ peptic ulcer
4_acute mesenteric ischemia
The correct diagnosis is 4_acute mesenteric ischemia
Ct abdomen and pelvis with contrast show the following
POST-CONTRAST MDCT SCAN OF THE ABDOMEN AND PELVIS REVEALED:-
Superior mesenteric artery:-
o Is seen of average caliber and adequate filling with normal
branching pattern.
o Normal aortomesenteric window measures about 16 mm; with
aortomesenteric angle measures 400 No significant compression
upon renal vein or third part of duodenum that are seen passing
freely through the aorto mesenteric window.
o The terminal part of SMA showed filling defect extending 6 cm.
o Relatively thickened enhanced walls of terminal ileum is seen.
Otherwise, The stomach, small and large bowel loops, showed
average caliber, normal wall thickness, with no dilatations or
diverticulae could be detected.
Normal hepatic size & average parenchymal texture, with no focal
hepatic lesions or IHBRD seen.
Normal size shape and texture of the spleen, no focal lesions.
Normal gall bladder shows no dense stones.
Normal CT appearance of the pancreas, suprarenal glands, both
kidneys, aorta and IVC.
No retrocrural , para-aortic or pelvic lymphadenopathy seen.
No ascites or localized collections could be detected.
Normal study of the U.B and other pelvic structure.
Lower thoracic cuts are unremarkable.
OPINION:
Features suggesting distal SMA thrombosis with mild distal ileal
ischaemic changes, for further workup.
Otherwise, Normal CT study of the abdomen and pelvic organs
