Pediatric Small Bowel Ischemia

Etiology Acute:
— Arterial embolus to superior mesenteric artery
— Closed loop obstruction of small bowel
Etiology Chronic: Radiation damage to superior mesenteric artery
Imaging Acute:
— Filling defect in mesenteric vessels
— Portal venous gas
— Pneumatosis intestinali
— Decreased enhancement of bowel wall
Imaging Chronic:
— Stenosis of mesenteric vessels
— Extensive collateral vessels
— Bowel wall thickening
— Pneumatosis intestinalis
DDX:
Complications:
Treatment:
Clinical:
— Acutely presents with acute abdomen
— Chronicly presents with post prandial abdominal pain = intestinal angina

Radiology Cases of Small Bowel Ischemia

Radiology Cases of Acute Small Bowel Ischemia

Radiology Cases of Acute Small Bowel Ischemia Due to Meckel Diverticulum Causing Small Bowel Volvulus and Closed Loop Obstruction

CT of Meckel diverticulum causing small bowel volvulus and a closed loop obstruction resulting in small bowel ischemia — Coronal (above left) CT with contrast of the abdomen shows in the center just above the bladder a C-shaped dilated small bowel loop with a thickened wall that is not enhancing. On the sagittal image (above right) the dilated, thickened and nonenhancing small bowel loop is seen anteriorly in the abdomen and superior to the bladder. On the axial image (below) the small bowel loop is in the center of the pelvis.

CT of Meckel diverticulum causing distal small obstruction due to small bowel volvulus around the Meckel diverticulum resulting in a closed loop obstruction and small bowel ischemia of the ileum and pneumatosis intestinalis from necrosis in the ileum — AXR AP (above left) shows multiple dilated loops of small bowel and a decomopressed colon. Coronal CT with contrast of the abdomen (above right) shows normal caliber and normal enhancement of the proximal jejunum loops in the left upper quadrant. The distal ileum loops in the right lower quadrant are dilated and do not enhance. There is pneumatosis intestinalis in the walls of the most lateral loop of ileum. Axial CT (below) again shows the pneumatosis in the walls of the most lateral loop of ileum on the right and again shows the difference in bowel wall enhancement between the normal jejunum on the left and the abnormal ileum on the right.

US of Meckel diverticulum — Transverse US of the abdomen (below) shows a non-peristalsing cystic lesion in the center of the image superiorly. Transverse US (above) shows a dilated loop of small bowel with an air-fluid level within it.

Radiology Cases of Chronic Small Bowel Ischemia

Radiology Cases of Chronic Small Bowel Ischemia Due to Malrotation With Chronic Midgut Volvulus

Upper GI of malrotation with chronic midgut volvulus — AP image from a small bowel follow through exam (below) shows the small bowel on the right side of the abdomen and the colon on the left side of the abdomen. Close examination of the upper GI portion of the exam (above) beyond the abnormal position of the ligament of Treitz shows a thickened appearance of the folds throughout the duodenum (above left) and proximal jejunum (above right) but there was no evidence of spiraling of the bowel or obstruction.

Radiology Cases of Chronic Small Bowel Ischemia Due to Radiation Induced Enteritis

Small bowel follow through of chronic intestinal ischemia — AP image from an upper GI and small bowel follow through exam shows marked thickening of the small bowel folds throughout the jejunum.