Question:

Which of the following statements about a closed loop obstruction is false?
1. A "whirl sign" can be seen.
2. Closed loop obstructions can result from malrotation or prior abdominal surgery.
3. The enhancement pattern is variable.
4. Closed loop obstructions are often related to a hypercoagulable state.
5. There is often bowel wall thickening.





Answer:

The correct answer for the question "Which of the following statements about a closed loop obstruction is false?" is:

4. Closed loop obstructions are often related to a hypercoagulable state.



Explanation
1. A "whirl sign" is one of the features more specific to a closed loop obstruction. [In the case of a mechanical obstruction, a closed loop or "whirl" sign can be seen.]

2. Closed loop obstructions can result from malrotation or prior abdominal surgery. [A history of prior abdominal surgery or known malrotation can be an important clue in raising suspicion for a closed loop obstruction with possible resultant ischemia.]

3. The enhancement pattern of closed loop obstructions like most other causes of mesenteric ischemia is variable.  [Imaging findings of ischemia in the setting of a mechanical obstruction include wall thickening and adjacent mesenteric fluid; however, the enhancement pattern is variable [4].]

4. Venous occlusion is the cause of mesenteric ischemia most often related to a hypercoagulable state, not a closed loop obstruction.  [Venocclusive causes of ischemia are often more subacute in presentation, and risk factors for mesenteric venous occlusion include slowed venous transit from portal hypertension or right-sided heart failure and hypercoagulable states, which have long been associated with a risk of venous thrombosis.]

5. There is often bowel wall thickening.  [Bowel wall edema will typically manifest as thickening greater than 3 mm and can have decreased attenuation [4].  Typical thickness in the setting of mesenteric ischemia is 8-9 mm [4,11].]



From the manuscript:
Ischemic Bowel: Uncommon Imaging Findings in a Case of Cocaine Enteropathy
Radiology Case. 2013 Feb; 7(2):38-43


This article belongs to the GI section.




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From the manuscript

Ischemic Bowel: Uncommon Imaging Findings in a Case of Cocaine Enteropathy

Free full text article: Ischemic Bowel: Uncommon Imaging Findings in a Case of Cocaine Enteropathy

Abstract
While the clinical findings of cocaine-induced enteropathy from mesenteric ischemia are fairly well understood, there is a paucity of imaging description and detail in the literature that describes these findings. Imaging characteristics of cocaine-induced mesenteric ischemia on CT examination include bowel edema, mucosal enhancement, venous engorgement, mesenteric free fluid, and dilatation of the small bowel lumen. A thorough history, physical examination, and laboratory testing are critical for the diagnosis and prompt surgical intervention may be necessary. We present a case of cocaine-induced mesenteric ischemia in a 49 year old male which resolved within 24 hours of supportive therapy.






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