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Episode 29: Diagnostic Dilemma – “Ileus”

Description 🎙️

We're back! Andrew presents a case of "ileus" — a gut that's gone eerily quiet, until a twist reveals it was never being lazy.

Imaging 🩻

Initial CT (Admission #1), Non-enhanced

Axial non-contrast enhanced CT images through the abdomen (A, B) show distended loops of small bowel containing fluid and air-fluid levels. The terminal ileum appears normal in caliber as it enters the cecum (B, white arrow). No transition point was seen. 
Axial non-contrast enhanced CT images through the abdomen (A, B) show distended loops of small bowel containing fluid and air-fluid levels. The terminal ileum appears normal in caliber as it enters the cecum (B, white arrow). No transition point was seen. 

Repeat CT (Admission #1), Non-enhanced

Axial non-contrast enhanced CT images of the mid abdomen (A, B) show distended loops of small bowel with air-fluid levels (yellow arrows in B). Axial and coronal non-contrast enhanced CT images (B, C) demonstrate the terminal ileum is collapsed (white arrow). 
Axial non-contrast enhanced CT images of the mid abdomen (A, B) show distended loops of small bowel with air-fluid levels (yellow arrows in B). Axial and coronal non-contrast enhanced CT images (B, C) demonstrate the terminal ileum is collapsed (white arrow). 

Repeat CT (Admission #2), Non-enhanced

Axial (A, B), and coronal (C) non-contrast enhanced CT images of the mid abdomen show increased dilation of loops of small bowel which contain fluid and air-fluid levels (yellow arrows). Axial non-contrast enhanced CT image (D) shows the collapsed terminal ileum. There is a gradual decrease in caliber of the ileum, with the terminal ileum (white arrow) collapsed. No discrete mass was identified. 
Axial (A, B), and coronal (C) non-contrast enhanced CT images of the mid abdomen show increased dilation of loops of small bowel which contain fluid and air-fluid levels (yellow arrows). Axial non-contrast enhanced CT image (D) shows the collapsed terminal ileum. There is a gradual decrease in caliber of the ileum, with the terminal ileum (white arrow) collapsed. No discrete mass was identified. 

Teaching ✍️