GI Radiology > Small Bowel > Quiz > Case 3 Answers

Quiz: Case 3 Answers

10. What structure is being imaged here?
Ligament of Treitz
Terminal ileum

This is a magnified spot film of the terminal ileum during a single-contrast small bowel follow-through. Careful evaluation of the terminal is necessary for a complete SBFT because of its propensity to be involved in small bowel disease. Several inflammatory, infectious, and neoplastic processes can cause isolated disease. Evaluation of the terminal ileum may be enhanced with prone compression views or peroral pneumocolon. Prone compression views entail using a paddle to compress the right lower quadrant while the patient lies on their stomach. Peroral pneumocolon entails infusion of air through a rectal tube until air is refluxed through the colon and ileocecal valve into the terminal ileum. This allows for a double-contrast evaluation of the terminal ileum and a more sensitive view of the mucosal surface.

11. What is the salient finding?
Bowel dilatation
A and B
All of the above

There is marked, smooth narrowing of the terminal ileum as it arcs rightward into the ileocecal junction. This is the typical appearance of a stricture. In addition, there are at least two linear tracts emanating leftward, which represent fistulas. Fistulas may aberrantly connect the small bowel to the vagina (enterovaginal), skin (enterocutaneous), bladder (enterovesicular), small bowel (enteroenteral), or colon (enterocolic).

12. What is the possible etiology of these findings?
All of the above

Luminal narrowing can represent acute or chronic disease. Acute processes would include bowel wall infiltration with inflammation, edema, hemorrhage, or cells. However, the constellation of luminal narrowing and fistulas suggests a more chronic, transmural process. Strictures of this sort usually represent fibrotic changes and can be seen in chronic inflammatory (Crohn's disease), infectious (TB), neoplastic (lymphoma), or ischemic diseases, or as a result radiation.

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