0:00

Here we have another case.

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This is a contrast-enhanced CT

0:03

scan of the abdomen and pelvis.

0:05

As we come down, we can see a little

0:06

anastomosis here between the liver and the IVC.

0:09

This patient indeed has had a liver transplant.

0:12

I can tell you at our hospital, if I only

0:14

see one transplanted organ, I am happy.

0:16

It seems like the transplants have shot up, and we

0:19

have transplanted livers and kidneys in half of

0:22

our patients, but this is a nice liver transplant.

0:24

It looks pretty good here.

0:27

Here is the spleen.

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Pancreas is nice and atrophic, but still there.

0:31

And as we come down, we're going to

0:32

see this loop of small bowel.

0:35

Look at that abnormal loop of small bowel.

0:37

You can see all those little tiny folds of

0:38

the valvulae conniventes that, I'll tell you, this

0:40

small bowel, but you see a lot of fluid.

0:44

In the mesentery, right.

0:46

And some engorgement of the vessels as well.

0:48

So, you know, on our prior studies, I told you

0:51

that that was sometimes a finding of closed

0:52

loop obstruction, but I'll tell you, it's not

0:55

always a cause of closed loop obstruction, right?

0:58

Because the closed loop obstruction had that

0:59

very thickened small bowel with the fluid in the

1:02

mesentery, such as this case because the venous

1:07

outflow of the bowel was being

1:09

compromised by that tight obstruction.

1:12

Well, venous outflow to the bowel can cause bowel

1:17

wall thickening, whether it's from an obstruction

1:19

causing pinching off the veins or a venous thrombosis.

1:23

So I need you to always look for

1:25

that as an alternative reasoning for.

1:28

This very thickened small bowel loop.

1:30

So here's thickened small bowel

1:32

loop, lots of mesenteric fluid.

1:34

We know there's some reason why the vein

1:35

isn't draining, and in this case we'll

1:37

see that this vein is not enhancing well.

1:40

And as we move up, we'll see that

1:42

indeed it comes into the SMV, and you

1:45

can see that there is indeed a thrombus.

1:47

So this is one of the mesenteric

1:50

veins causing thrombosis and resultant

1:52

wet ischemia of this small bowel.

1:55

So, when you see very dilated, very thickened walls like

1:56

51 00:02:00,030 --> 00:02:03,990 this, you have to decide what is the cause for that

2:04

mesenteric fluid, and SMV thrombosis is one of them.