14529 Valluru Balakrishna

Tagged in Imaging / Ultrasound / Radiology

The Bowel's Grip

A 90 year old male presented with severe central abdominal pain associated with recurrent episodes of coffee ground vomitus without melena since one day.

He had a background history of transitional carcinoma of urinary bladder which was operated, atrial fibrillation, heart failure and a non-operable abdominal aortic aneurysm under surveillance.

Clinically he was stable with unremarkable observations, and a point of care ultrasound showed an abdominal aortic aneurysm measuring 8.6 cm with an incidental mass in the aneurysmal sac.

An urgent CT aortogram confirmed a large infrarenal abdominal aortic aneurysm measuring 9 cm as well as revealing small bowel herniation into the aneurysmal sac with thrombus formation

(Panel A & B arrows). There was no intra or retroperitoneal haematoma and no aortic-enteric fistula

This patient was admitted under the vascular team for conservative management. He had no further episodes of haemorrhage and was discharged back to the community for palliative care.

On a surveillance ultrasound scan done 10 months later the aneurysm was measuring 8.34cm with a mobile component.

This presentation highlights the fact that the bowel can herniate through the aneurysmal sac and act as a plug to prevent a catastrophic event.