Presentation
Presented with chronic obstipation and weight loss.
Patient Data
There is dilated bowel occupying the majority of the abdomen, giving it a distended appearance. The dilated loops are filled with fluid and mineral opacity material. The loops could be colon, however they seem more extensive than the normal amount of large intestine. There is a small amount of gas in the terminal colon and rectum, which is not filled with fecal material.
A barium enema was performed (images 3-4), which confirmed that the dilated bowel was not large intestine in origin.
Chronic partial obstruction likely due to an intestinal mass in the distal small intestine.
Case Discussion
Stricture due to adenocarcinoma of the ileum. The distended jejunum and ileum were resected. The adenocarcinoma caused fibroplastic response of the distal ileum and smooth muscle hypertrophy on histopathology.
The mineral material in the small intestine oral to the obstruction is characteristic of a "gravel sign", or accumulation of particulate matter that is too large to pass through the intestinal lumen at the site of obstruction.
The stricture site is only mildly abnormal on ultrasound, but its position in the ileum is characteristic of this tumor type. Recognizing that it is the site of obstruction, and there is no "mass" visible is key to the imaging diagnosis.
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