A 28-year-old man was brought to the emergency department with a gunshot wound to the abdomen. Immediate exploratory laparotomy showed perforation of the jejunum and an adjacent, nonexpanding mesenteric hematoma. The jejunum was partly resected, but the hematoma was not evacuated. After operation, serum levels of alkaline phosphatase and bilirubin were elevated, and the patient vomited bilious fluid. Cholescintigraphy performed to exclude biliary obstruction or leakage showed persistent nonvisualization of the third and fourth portions of the duodenum. Combined with retrograde shunting of radiotracer into a relatively dilated stomach, partial obstruction of the duodenum can be diagnosed based on the current examination. Correlation with a computed tomographic scan indicated a mesenteric hematoma as the anatomic cause of this finding.
- Biliary scintigraphy
- Bowel obstruction
ASJC Scopus subject areas
- Radiology Nuclear Medicine and imaging