Gastroenterology

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Adult female with abdominal pain, hepatomegaly, diarrhea, and multiple episodes of pseudoobstruction
Scleroderma

  • Systemic disorder with Skeletal, renal, pulmonary and gastrointestinal manifestations
  • SB: Hidebound(stacked coins) Ė normal thickness/tightly packed within dilated segment Pseudodivertuculi messenteric border from scarring. Pneumatosis coli intestinalis

Hidebound or stacked coin pattern with pseudodiverticula of antimessenteric border

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Duke Notes SB Diverticuli

  • Diverticulosis Ė messenteric border, acquired outpouchings ie colon with same string of associations
  • Meckelís diverticulum Ė remnant of omphalomessentric duct, arises in distal ileum, antimessentric, rule of 2ís(w/l 2 ft IC valve, length 2 in., present age<2), 1/3 contain gastric mucosa, 2/3 symptomatic contain gastric mucosa
  • Pseudodiverticuli/sacculations Ė cinching on antimessenteric border from chronic inflammatory disease with fibrosis(Crohns) and muscle atrophy(Scleroderma)
Meckelís Diverticulum
Meckelís diverticulum on SBFT(arrow) during contraction (left) and filling phase (right)
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Meckelís diverticulum attached to the umbilicus by the obliterated omphalomesentric duct
Rectal contrasted CT demonstrating inverted Meckelís diverticulum with intussusception. Notice the central fat and soft tissue filling defect
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Small bowel barium examination, demonstrates numerous bariumfilled messenteric
border diverticuli. Notice the absence of hidebound pattern seen in Scleroderma and strictures/fistula seen in Crohnís.

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