Adult intestinal failure

Typical request card, usually with “? Anatomy.” Numbers on the request card are used in radiological reports to help communicate with the clinicians. The arrows indicate anterior abdominal wall stomata or enterocutaneous fistulae.

Jejunostogram (catheter arrowed) connects opening 3 on the request card to a short segment of small bowel and colon (arrowheads).

Subsequent fistulogram (catheter arrowed) via fistula 5 fills the same loop of small bowel and colon shown at jejunostogram (arrowheads). Fistula 4 showed similar findings.

Interval fistulography via fistula 6 (catheter balloon arrowed) leads to small bowel and distal colon of the same loop. Thus, the anatomy of openings 3, 4, 5, and 6 are now defined in relation to the bowel, the length and quality of which have been partly assessed by their imaging characteristics.

Axial, portal venous-phase CT image showing a soft-tissue mass at the mesenteric root in a patient with lymphoma (arrow).

There was a tiny surface fistula to the abdominal wall in this patient, only large enough to admit a 16 G cannula for fistulography (arrowed). Although communication to bowel was demonstrated (arrowheads), exact anatomy is unclear.

CT fistulography shows the fistula site on the abdominal wall (arrow) leading to a loop of small bowel in the left iliac fossa (arrowhead).

This small bowel loop is traced across the abdomen to the right flank (arrowheads), corresponding to the loop seen in Fig. 6. The volumetric dataset of CT allowed excellent three-dimensional mapping of these bowel loops where fluoroscopy had failed.

Severe distal Crohn's disease. Note marked loop separation, mesenteric shortening, and anti-mesenteric sacculation, with sharp “rose-thorn” ulceration on the more cranial loop and upstream dilatation.

Coronal half-Fourier axial single-shot fast spin-echo MRI image in the same patient as Fig. 9 demonstrating a similar contour to the lumen of the distal ileal loops with florid wall thickening (the patient had refused naso-jejunal intubation for formal MRI enteroclysis).

Flowchart illustrating the cycle of complex surgery followed by multiple complications and nutritional decline.

Portal venous-phase CT image demonstrates a filling defect in the superior mesenteric vein (arrow), with a thickened and abnormal adjacent bowel loop (arrowhead).

Contrast angiography shows a diffuse field change with hypervascularity in radiotherapy-damaged bowel.

This patient had extremely abnormal gut motility, with severely delayed small bowel transit clinically, radiologically, and by nuclear medicine. The coronal reformat from multidetector CT demonstrates significantly dilated small bowel loops with no mechanical obstruction or point of transition. There is abnormal “slurry-like” small bowel content, suggestive of stasis and bacterial overgrowth, confirmed on breath testing.

CT following blunt trauma from a car accident shows a triangular fluid pocket close to thick-walled, briskly enhancing loops of small bowel (arrowhead). Several tiny pockets of free gas are visible anteriorly (arrows). The patient underwent laparotomy, where perforation and mesenteric tear with haemorrhage was confirmed.

This patient had required numerous indwelling central venous catheters for long-term parenteral nutrition as an adjunct to enteral feeding. The coronal minimum intensity projection images from this post-gadolinium MR venography show bilateral subclavian occlusions (arrowheads) with collateral vessel formation.