İnce barsakta yalancı iskemi bulguları

Özet

İnce barsak duvarında kalınlaşma veya anormal kontrastlanma tek başına iskemi tanısı koydurmaz; infeksiyon, inflamasyon, sistemik hipoperfüzyon ve ans kollapsı benzer görüntüler oluşturabilir. BT anjiyografi mezenterik arter ve venlerdeki trombozu saptamaya, tutulumun kapsamını değerlendirmeye yardımcı olur. Taklitçiyi gerçek iskemi sanmak gereksiz alarm yaratabilir; tersine şok barsağını ya da eşlik eden fokal iskemi alanını yalnızca yaygın enterit diye açıklamak tedaviyi geciktirebilir.

Faz ve pencere

BTA tanısal

Mezenterik arter ve venlerde tromboz araştırılır; damar tıkanıklığı olmaksızın gelişen ağır intestinal hipoperfüzyon non-oklüzif mezenterik iskemiyle (NOMI) uyumludur.

Portal tanısal

Barsak duvarı kontrastlanması anslar arasında karşılaştırılır; azalmış duvar kontrastlanması iskemi değerlendirmesinde kullanılan BT bulgularındandır.

Kontrastsız

Kontrastsız BT görüntüleri bağırsak duvarı atenüasyonunun değerlendirilmesini sağlar.

BT bulguları

• İyotlu kontrast maddeye aşırı duyarlılık ve şok gelişen bir köpekte BT’de intestinal mukozada yoğun kontrastlanma bildirilmiştir. Şokla ilişkili BT bulguları hemodinamik bağlamda değerlendirilmelidir.
• Aktif Crohn hastalığında bağırsak duvarı kalınlaşması ve ödemin yanı sıra perimural inflamasyon, ülserasyon ve hipervaskülarite görülebilir.
• Kollabe ince barsak ansını değerlendirirken dilate proksimal ve kollabe distal anslar arasındaki geçiş zonunu ara; bu görünüm obstrüksiyonda görülebilir. Dilate proksimal ve kollabe distal anslar arasındaki belirgin geçiş zonu ince barsak obstrüksiyonunu düşündürebilir.
• İskemiye eşlik edebilecek BT bulguları arasında mezenterik damar trombozu, azalmış bağırsak duvarı kontrastlanması, mezenterik bulanıklık, pnömatozis ve portal ya da mezenterik venöz gaz bulunur.
• Akut mezenter iskemi şüphesinde BT anjiyografi arteriyel ve venöz fazları içermeli; mezenterik arter ve venlerde tromboz ile barsak tutulumunun kapsamı değerlendirilmelidir.

Normalde

Şüpheli barsak segmentinin duvar kontrastlanmasını etkilenmemiş segmentlerle karşılaştır; azalmış duvar kontrastlanması iskemi değerlendirmesinde kullanılan BT bulgularındandır. Duvar kontrastlanmasını etkilenmiş ve sağlıklı barsak segmentleri arasında karşılaştır; akut barsak iskemisinde segmentler arasında duvar yoğunluğu farkı bildirilmiştir.

Ayırıcı tanı

Aktif Crohn enteritinde duvar kalınlaşması ve ödemle birlikte perimural inflamasyon, ülserasyon ve hipervaskülarite görülebilir.

Şokta BT hipoperfüzyon kompleksinin abdominal vasküler ve visseral bulguları görülebilir; abdominal organlarda azalmış kontrastlanma bildirilen bulgular arasındadır.

Mekanik ince bağırsak obstrüksiyonunda iskemi değerlendirilirken azalmış duvar kontrastlanması, mezenterik bulanıklık ve kapalı ans mekanizması birlikte dikkate alınabilir.

Tuzaklar

• Kollabe ansı, dilate proksimal ve kollabe distal anslar arasındaki geçiş zonu açısından değerlendir.
• Şokta BT hipoperfüzyon kompleksinin abdominal vasküler ve visseral bulgularını değerlendir; barsak duvarında azalmış kontrastlanma iskemi değerlendirmesinde kullanılan bulgulardandır.
• Şokla ilişkili BT bulguları arasında abdominal organlarda kontrastlanma azalması bildirildiğinden, organ kontrastlanmasını hemodinamik bağlamda değerlendir.

Kendini dene

1. Hipoperfüzyonlu bir hastada kontrastlı BT’de yaygın barsak duvarı kontrastlanma kaybı görülüyor ve SMA’da oklüzif lezyon saptanmıyor. Bu bulgular en çok hangi durumla uyumludur?

   • Non-oklüzif mezenterik iskemi (NOMI)
   • SMA embolisi
   • Kapalı ans sendromu
   • İntramural hematom
   Cevabı göster

   Non-oklüzif mezenterik iskemi (NOMI). NOMI, mezenterik arterlerde tıkayıcı bir lezyon olmaksızın gelişen ağır intestinal hipoperfüzyonla ilişkilidir.

2. BT’de dilate proksimal ve kollabe distal ince barsak ansları arasında belirgin geçiş zonu görülüyor. Bu örüntü en çok hangi durumu düşündürür?

   • Mekanik ince barsak obstrüksiyonu
   • Paralitik ileus
   • Aktif enterit
   • Normal ince barsak görünümü
   Cevabı göster

   Mekanik ince barsak obstrüksiyonu. Dilate proksimal ve kollabe distal anslar arasındaki belirgin geçiş zonu, ince barsak obstrüksiyonunda görülebilen bir BT örüntüsüdür.

Bu konunun yer aldığı turlar

• Akut karın BT'si
• Normal varyantlar ve taklitçiler: sık yanılgılar

Kaynaklar

Bu sayfadaki 33 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla otomatik olarak karşılaştırıldı; 26 cümle bu karşılaştırmada düzeltildi (2026-10-09).

1. Double Trouble: A Diagnostic Challenge of Coexisting Encapsulating Peritonitis and Transverse Mesocolic Internal Hernia Presenting As Acute Small Bowel Obstructionpmc.ncbi.nlm.nih.gov
2. Spontaneous transomental internal hernia causing small bowel obstruction in an elderly patient with a virgin abdomen: a case reportpmc.ncbi.nlm.nih.gov
3. Epiploic–mesenteric knotting as a rare cause of small-bowel obstructionpmc.ncbi.nlm.nih.gov
4. Caught in the Whirl: A Case Report of Midgut Volvulus in an Elderly Patientpmc.ncbi.nlm.nih.gov
5. Greater Omental Torsion With Reactive Periappendicitis: A Case Report From a Second-Level Care Hospitalpmc.ncbi.nlm.nih.gov
6. Gangrenous Gastritis: Unusual Cause Of Upper Gi Bleeding.pubmed.ncbi.nlm.nih.gov
7. A Rare Case of Hypermobile Mesentery With Segmental Small Bowel Pneumatosis Cystoides Intestinalis.pubmed.ncbi.nlm.nih.gov
8. An ingestible capsule for luminance-based diagnosis of mesenteric ischemia.pubmed.ncbi.nlm.nih.gov
9. Superior mesenteric artery dissection with aneurysm, hematoma, and bowel ischemia mimicking pancreatitis: a rare case image report.pubmed.ncbi.nlm.nih.gov
10. Beyond the Watershed: Chronic Ischemic Colitis Masking Underlying Small Bowel Non-Hodgkin Lymphoma.pubmed.ncbi.nlm.nih.gov
11. Spontaneous mesenteric hemorrhage following a sneezing episode associated with an intestinal pseudodiverticulum: a case report.pubmed.ncbi.nlm.nih.gov
12. An Acute-on-Chronic Presentation of Pneumatosis Cystoides Intestinalis: A Case Report.pubmed.ncbi.nlm.nih.gov
13. From ruptured ovarian cyst to ileo-ileal knotting: a case of diagnostic dilemma.pubmed.ncbi.nlm.nih.gov
14. Angiotensin-Converting Enzyme (ACE) Inhibitor-Associated Hypersensitivity Vasculitis With Small Bowel Edema: A Case Report.pubmed.ncbi.nlm.nih.gov
15. Fruit pit mimicking gallstone ileus: A diagnostic pitfall on CT-Case report.pubmed.ncbi.nlm.nih.gov
16. Ileal tuberculosis presenting with severe unexplained anemia and unusual pseudo-tumoral imaging features: A case report.pubmed.ncbi.nlm.nih.gov
17. Report of Meckel Diverticulum Mimicking Stricturing Crohn's Disease in an Adolescent Boy.pubmed.ncbi.nlm.nih.gov
18. Jejunal Perforation Associated With a Horseshoe-Shaped Abdominal Contusion After a Horse Kick: A Case Report.pubmed.ncbi.nlm.nih.gov
19. Case Report: Acute superior mesenteric vein and portal vein thrombosis complicated by small intestinal necrosis: a case of successful endovascular treatment.pubmed.ncbi.nlm.nih.gov
20. Hepatic portal venous gas in severe neurocritical illness after intracranial surgery: Two case reports and literature review.pubmed.ncbi.nlm.nih.gov
21. Small Bowel Ischemia Secondary to Splanchnic Venous Thrombosis in a Postpartum Patient-A Case Report.pubmed.ncbi.nlm.nih.gov
22. Double Trouble: A Diagnostic Challenge of Coexisting Encapsulating Peritonitis and Transverse Mesocolic Internal Hernia Presenting As Acute Small Bowel Obstruction.pubmed.ncbi.nlm.nih.gov
23. Endovascular Treatment of an Iatrogenic Inferior Mesenteric Arteriovenous Fistula Presenting as Massive Lower Gastrointestinal Hemorrhage: A Case Report.pubmed.ncbi.nlm.nih.gov
24. Intestinal necrosis in a patient with Behçet's disease and infective endocarditis: a case report.pubmed.ncbi.nlm.nih.gov
25. Catheter-Directed Thrombolysis for Acute Superior Mesenteric Artery Occlusion: A Case Report.pubmed.ncbi.nlm.nih.gov
26. Open superior mesenteric artery thrombectomy of dislodged aortic valve causing acute mesenteric ischemia.pubmed.ncbi.nlm.nih.gov
27. Review of COVID-19, part 1: Abdominal manifestations in adults and multisystem inflammatory syndrome in children.pubmed.ncbi.nlm.nih.gov
28. Multisystem Imaging Manifestations of COVID-19, Part 2: From Cardiac Complications to Pediatric Manifestations.pubmed.ncbi.nlm.nih.gov
29. Imaging of abdominal and pelvic infections in the cancer patient.pubmed.ncbi.nlm.nih.gov
30. Gas Beyond the Lumen: Gastric Pneumatosis With Portal Venous Gas Following Blunt Abdominal Trauma.pubmed.ncbi.nlm.nih.gov
31. Colonic Ischemia in a Patient With Pemphigus Vulgaris: Coincidence or Causation.pubmed.ncbi.nlm.nih.gov
32. Ischemic Gastroduodenitis: Navigating the Challenges of Enteral Nutrition Resumption.pubmed.ncbi.nlm.nih.gov
33. Delayed presentation of left-sided penetrating diaphragmatic injury with multivisceral herniation, gastric fundal perforation, and splenic laceration leading to fatal septic shock: a case report from Ethiopia.pubmed.ncbi.nlm.nih.gov
34. A Rare Finding of Retroperitoneal Sepsis Following Robot-Assisted Transanal Minimally Invasive Surgery (TAMIS): A Case Report and Review of the Literature.pubmed.ncbi.nlm.nih.gov
35. Stricturing Diseases of the Gastrointestinal Tract-Current Clinical Practice.pubmed.ncbi.nlm.nih.gov
36. Analysis of clinical characteristics of 117 cases of ischemic colitis.pubmed.ncbi.nlm.nih.gov
37. Gastrointestinal complications in intensive care.pubmed.ncbi.nlm.nih.gov
38. Analysis of CT and MRI imaging features of ectopic pancreas.pubmed.ncbi.nlm.nih.gov
39. Protection against necrotic enteritis in broiler chickens by co-administration of Enterococcus faecalis EF32 and recombinant Lactobacillus plantarum strain co-expressing FimA, FimB, NetB and Fba.pubmed.ncbi.nlm.nih.gov
40. Effects of esculetin on growth performance, carcass traits, intestinal morphology, digestive enzyme, barrier function and cecal microbiota in broiler chickens.pubmed.ncbi.nlm.nih.gov
41. Contrast-enhanced ultrasound in critical care: a problem-solving approach.pubmed.ncbi.nlm.nih.gov
42. Relative colon wall attenuation - distinguishing ischemia from other colon wall changes.pubmed.ncbi.nlm.nih.gov
43. Current Evidence on the Management of Non-occlusive Mesenteric Ischemia: A Comprehensive Narrative Review.pubmed.ncbi.nlm.nih.gov
44. Clinical and CT features of patients with pneumatosis intestinalis: A retrospective single-center study.pubmed.ncbi.nlm.nih.gov
45. Pneumatosis intestinalis revisited: associated imaging findings, clinical correlation, management, risk stratification and future perspectives.pubmed.ncbi.nlm.nih.gov
46. POCUS for acute abdominal pain: practical scan protocols on gastrointestinal diseases and an evidence review.pubmed.ncbi.nlm.nih.gov
47. Bowel Blockage Without a Block: Amyloidosis Presenting as Chronic Intestinal Pseudo-Obstruction.pubmed.ncbi.nlm.nih.gov
48. Small Bowel Imaging from Stepchild of Roentgenology to MR Enterography: Part I: Guidance in Performing and Observing Normal and Abnormal Imaging Findings.pubmed.ncbi.nlm.nih.gov
49. Acute bowel ischemia in the absence of radiological findings: A case for endoscopy.pubmed.ncbi.nlm.nih.gov
50. Sustained clinical stability with telitacicept-containing maintenance therapy following glucocorticoid and IVIG induction for lupus enteritis with autoimmune hemolytic anemia: a case report.pubmed.ncbi.nlm.nih.gov
51. Role of magnetic resonance in bowel pathologies: Beyond inflammatory bowel disease.pubmed.ncbi.nlm.nih.gov
52. Crohn's disease: research progress in decoding pathogenic multi-network and precision management of artificial intelligence radiomics.pubmed.ncbi.nlm.nih.gov
53. ESR Essentials: diagnosis and assessment of treatment response in patients with luminal Crohn's disease-practice recommendations by the European Society of Gastrointestinal and Abdominal Radiology.pubmed.ncbi.nlm.nih.gov
54. Can Creeping Fat Be a Prognostic Factor in Crohn's Disease?pubmed.ncbi.nlm.nih.gov
55. Assessing Pancreatic Enhancement Variability in ICU Patients with CT Hypoperfusion Complex: A Retrospective Single-Center Study.pubmed.ncbi.nlm.nih.gov
56. Adult Hepatic Infarction for Internists: A Practical Diagnostic and Management Pathway to Avoid Misdiagnosis, Unnecessary Drainage, and Delayed Vascular Recognition.pubmed.ncbi.nlm.nih.gov
57. Intramural Hematoma of Gastrointestinal Tract in People with Hemophilia A and B.pubmed.ncbi.nlm.nih.gov
58. Preoperative Suspicion of Internal Hernia and Laparoscopic Repair of a Congenital Transmesocolic Hernia Presenting as Closed-Loop Small-Bowel Obstruction: A Case Report.pubmed.ncbi.nlm.nih.gov
59. Impact of surgical delay on bowel viability in internal hernia-related small bowel obstructon: a retrospective cohort study of clinical, imaging, and biochemical predictors of strangulation.pubmed.ncbi.nlm.nih.gov
60. Right paraduodenal hernia complicated with small bowel obstruction and midgut rotation: a case report.pubmed.ncbi.nlm.nih.gov
61. International Society of Paediatric Surgical Oncology (IPSO) Surgical Practice Guidelines.pubmed.ncbi.nlm.nih.gov
62. Long-term safety and effectiveness of the "OptEase" vena cava filter.pubmed.ncbi.nlm.nih.gov
63. Patterns of injury and violence in Yaoundé Cameroon: an analysis of hospital data.pubmed.ncbi.nlm.nih.gov
64. Ischemic colitis in a child: a case report and narrative review.pubmed.ncbi.nlm.nih.gov
65. Severe gastrointestinal manifestations in childhood-onset lupus: A single-center cohort and review of the literature.pubmed.ncbi.nlm.nih.gov
66. Bacterial dysentery complicated with Crohn's disease: A case report.pubmed.ncbi.nlm.nih.gov
67. Advancing precision triage in strangulated small bowel obstruction: from static scores to dynamic multiparametric models.pubmed.ncbi.nlm.nih.gov
68. Case Report: Leiomyosarcoma of the inferior vena cava presenting as a right atrial mass: the value of multimodality imaging.pubmed.ncbi.nlm.nih.gov
69. Fulminant emphysematous hepatitis with pneumoperitoneum: A case report.pubmed.ncbi.nlm.nih.gov
70. Extensive Multicompartmental Air Dissection With Pneumoscrotum and Pneumorrhachis After Perineal Compressed-Air Injury Without Demonstrable Persistent Full-Thickness Rectal Perforation: A Case Report.pubmed.ncbi.nlm.nih.gov
71. Cholecystogastric fistula masquerading as gastrointestinal stromal tumour: Unusual presentation of gallbladder adenomyomatosis - a case report.pubmed.ncbi.nlm.nih.gov
72. Abdominal Cocoon Syndrome Masquerading as Intussusception on Computed Tomography: A Case Report.pubmed.ncbi.nlm.nih.gov
73. Comprehensive Imaging Evaluation and Staging of Crohn's Disease: When and Why to Use Intestinal Ultrasound, MRE, or CTE: Current Guidelines and Future Directions.pubmed.ncbi.nlm.nih.gov
74. Computed Tomography and Magnetic Resonance Enterography: From Protocols to Diagnosis.pubmed.ncbi.nlm.nih.gov
75. Histotripsy of the Proximal Ureter and Renal Pelvis: Evaluation of Urothelial Injury in a Porcine Survival Model.pubmed.ncbi.nlm.nih.gov
76. Non-occlusive mesenteric ischemia secondary to diabetic ketoacidosis in a patient receiving olanzapine: A case report.pubmed.ncbi.nlm.nih.gov
77. The Importance of Predicting Bowel Necrosis in Acute Mesenteric Ischemia: Narrative Review.pubmed.ncbi.nlm.nih.gov
78. International Consensus Statement on Obstructive Sleep Apnea.pubmed.ncbi.nlm.nih.gov
79. Intensive care course after stage 1 Norwood procedure: are there early predictors of failure?pubmed.ncbi.nlm.nih.gov
80. Caught in the Whirl: A Case Report of Midgut Volvulus in an Elderly Patient.pubmed.ncbi.nlm.nih.gov
81. Spontaneous transomental internal hernia causing small bowel obstruction in an elderly patient with a virgin abdomen: a case report.pubmed.ncbi.nlm.nih.gov
82. Many faces of acute bowel ischemia: overview of radiologic staging.pubmed.ncbi.nlm.nih.gov
83. Advances in Imaging and Diagnosis of Emphysematous Cholecystitis.pubmed.ncbi.nlm.nih.gov
84. Migraine to Mesenteric Mishap: A Case Report of Ischemic Colitis Due to Sumatriptan.pubmed.ncbi.nlm.nih.gov
85. CT of acute abdomen in the elderly.pubmed.ncbi.nlm.nih.gov
86. Utility of Dual-Energy Computed Tomography in Clinical Conundra.pubmed.ncbi.nlm.nih.gov
87. Diagnostic Role of Multi-Detector Computed Tomography in Acute Mesenteric Ischemia.pubmed.ncbi.nlm.nih.gov
88. A Case Report of Contrasting Pre- and Post-Emergency Percutaneous Catheter Drainage CT Images in Patients Having Trauma with Severe Abdominal Compartment Syndrome: A Valuable Tool for Identifying Hemorrhage Sources.pubmed.ncbi.nlm.nih.gov
89. Multidetector CT Imaging Biomarkers as Predictors of Prognosis in Shock: Updates and Future Directions.pubmed.ncbi.nlm.nih.gov
90. CT-based radiological score (AMESI CT-score) for severity of bowel injury in acute mesenteric ischemia.pubmed.ncbi.nlm.nih.gov
91. A Bedside Prediction Score for Strangulation in Adults With Acute Mechanical Intestinal Obstruction: A Prospective Cohort Study in Taiz, Yemen.pubmed.ncbi.nlm.nih.gov
92. Imaging diagnosis of cryptogenic multifocal ulcerous stenosing enteritis.pubmed.ncbi.nlm.nih.gov
93. Gastrointestinal Ultrasound in Infectious Diseases: A Comprehensive Review.pubmed.ncbi.nlm.nih.gov
94. Mesenteric ischemia: what the radiologist needs to know.pubmed.ncbi.nlm.nih.gov
95. A surgical case of anti-coagulant ileus mimicking small-bowel tumors: a case report.pubmed.ncbi.nlm.nih.gov
96. CT of Penetrating Abdominopelvic Trauma.pubmed.ncbi.nlm.nih.gov
97. Inflammatory bowel disease imaging: Current practice and future directions.pubmed.ncbi.nlm.nih.gov
98. Commentary: an eye on PET quantification.pubmed.ncbi.nlm.nih.gov
99. Imaging and clinical features of intra-abdominal injuries in children with suspected physical abuse.pubmed.ncbi.nlm.nih.gov
100. Society for Cardiovascular Magnetic Resonance 2024 Cases of SCMR case series.pubmed.ncbi.nlm.nih.gov
101. Imaging of penetrating vascular trauma of the body and extremities secondary to ballistic and stab wounds.pubmed.ncbi.nlm.nih.gov
102. Dietary <i>Echinacea purpurea</i> polysaccharide supplementation improves antioxidative status, intestinal immune, and structure of cecal microbiota in Mahuang chickens.pubmed.ncbi.nlm.nih.gov
103. Biosynthetic reuterin improved the intestinal health in pigs.pubmed.ncbi.nlm.nih.gov
104. Quantum dot butyrate: a novel strategy to improve performance, nutrient digestibility and gut barrier function in broilers.pubmed.ncbi.nlm.nih.gov
105. Human biomarker navigator.pubmed.ncbi.nlm.nih.gov
106. Noninvasive ultrasound elasticity imaging (UEI) of Crohn's disease: animal model.pubmed.ncbi.nlm.nih.gov
107. Mesenteric ischemia in patients with COVID-19: an updated systematic review of abdominal CT findings in 75 patients.pubmed.ncbi.nlm.nih.gov
108. Abdominal apoplexy complicating ulcerative colitis: a case report of venous mesenteric hemorrhage.pubmed.ncbi.nlm.nih.gov
109. Uterine Leiomyosarcoma Incidentally Diagnosed After Sigmoid Colon Perforation: A Case Report and Review of the Literature Highlighting Individualized Surgical and Oncologic Decision-Making.pubmed.ncbi.nlm.nih.gov
110. Early and Late Complications After Sleeve Gastrectomy and Roux-en-Y Gastric Bypass: A Narrative Review.pubmed.ncbi.nlm.nih.gov
111. Multiparametric Abdominal Ultrasound as a Source of Imaging Biomarkers in Predictive and Personalized Medicine: A Narrative Review.pubmed.ncbi.nlm.nih.gov
112. Computed Tomographic Findings and Clinical Manifestations of Acute Severe Hypersensitivity to a Non-Ionic Iodinated Contrast Agent in a Castrated Male Dog: A Case Report.pubmed.ncbi.nlm.nih.gov
113. CT manifestations of small bowel ischemia due to impaired venous drainage-with a correlation of pathologic findings.pubmed.ncbi.nlm.nih.gov
114. Value of dual-energy computed tomography in the diagnosis of bowel ischemia in patients with mechanical small-bowel obstruction: a retrospective, dual-center study.pubmed.ncbi.nlm.nih.gov
115. Virtual monochromatic versus conventional polychromatic CT images in patients with acute bowel ischaemia.pubmed.ncbi.nlm.nih.gov

Eğitim amaçlıdır; hasta başında tanı ve tedavi kararının yerine geçmez, tıbbi tavsiye değildir. Metinler yapay zekâ desteğiyle yazıldı ve otomatik bir adımda kaynak alıntılarıyla karşılaştırıldı; bu bir tıbbi doğrulama değildir ve içerik uzman radyolog incelemesinden geçmedi. Klinik kararlarda güncel kılavuzları, kurum protokollerini ve radyoloji raporunu esas alın.