Fig. 17

Bowel stricture with secondary bacterial overgrowth in a 44-year-old male with a history of primary antiphospholipid antibody syndrome. He presented with abdominal pain, fever, nausea, vomiting, and diarrhea without a history of previous surgery. CTE was obtained. Axial CT (A) shows evidence of chronic SMV thrombosis associated with multiple collateral veins in the mesenteric root (white dotted oval). CT images (B–D) demonstrate diffuse mural thickening at jejunal loops with submucosal edema and mucosal hyperenhancement (thick white arrows). There is an abrupt stricture in a segment of proximal ileum (thin white arrows) leading to upstream bowel dilatation (white asterisks) suggestive of partial obstruction with development of ascites. The clinical and imaging findings were suspicious for focal stricture secondary to an old vascular insult with secondary bacterial overgrowth in dilated jejunal and proximal ileal loops. The patient underwent antibiotic therapy, bowel rest, and conservative management resulting in improvement of signs/symptoms. He was discharged with an uneventful follow-up