case_images: PMC11813066_01
case_images: (A) Portal and superior mesenteric vein thrombosis (blue arrow). (B) A long segment of intestinal stenosis (blue arrow) with significant proximal bowel dilatation. (C) Digestive tract radiography revealed localized small bowel stenosis with a bird-beak sign (blue arrow). (D) Enteroscopy revealed circumferential jejunal stenosis with ulceration and obstruction. (E) Mucosal congestion and edema of the whole colon, loss of vascular texture and normal structure of the colon. (F) A band of adhesions at a narrow site of the small intestine. (G) A 10 cm jejunal stenosis (black arrow) with significant proximal intestinal dilation and edema (blue arrow).
case_images: medi-104-e41427-g001.jpg
case_images: PMC11813066_01_medi-104-e41427-g001.jpg
case_images: F1
case_images: The splenic vein was not visualized, and there was evidence of thrombosis in both the PV and SMV (Fig. 1A). Local small intestinal wall thickened and the lumen narrowed (Fig. 1B). Gastrointestinal radiograph showed localized small bowel stenosis with bird-beak sign (Fig. 1C). Enteroscopy was then performed and showed annular stenosis, ulceration, and obstruction of the jejunum approximately 150 cm distal to the pylorus, mucosal congestion and edema throughout the colon, loss of vascular texture and normal structure of the colon (Fig. 1D and E). Intraoperatively, a 10-cm stenosis of the intestine was identified approximately 140 cm distal to the ligament of Treitz, where there was adhesion between the small intestine, greater omentum, and anterior abdominal wall (Fig. 1F and G).
case_images: PMC11813066_02
case_images: (A) Hyperintense signal shadows are seen near the third ventricle, bilateral thalamus and midbrain ducts (blue arrow), considering Wernicke encephalopathy. (B) Gastrointestinal radiography revealed local stenosis of the jejunum with beak-like changes (blue arrow) and obvious dilatation of the proximal jejunum. (C) Circumferential jejunal stenosis with ulceration. (D) Adhesion was found between mesentery, omentum, and anterior abdominal wall. (E) A 9 cm of the jejunum was resected, the stenotic segment (black arrow) was 2 cm in length.
case_images: medi-104-e41427-g002.jpg
case_images: PMC11813066_02_medi-104-e41427-g002.jpg
case_images: F2
case_images: In addition, the patient exhibited rapid eye movements with dizziness and blurred vision, leading to further investigation by cranial magnetic resonance imaging, which confirmed the diagnosis of Wernicke encephalopathy (Fig. 2A). Gastrointestinal radiography identified localized stenosis of the small intestine in group 3, characterized by a beak-like appearance (Fig. 2B), with significant dilation of the proximal small intestine, measuring approximately 10 cm at its widest point. Enteroscopy revealed a small intestinal ulcer with stenosis located 110 cm from the pylorus (Fig. 2C). Intraoperatively, pronounced adhesions were observed in the upper abdomen, presenting as mesh adhesions (Fig. 2D). A portion of the small intestine about 1 m from the ligament of Treitz was completely wrapped by the omentum, and the lumen of this segment was markedly narrow (Fig. 2E).
case_images: PMC11813066_03
case_images: (A) Gastrointestinal radiography showed local stenosis of the small intestine (black arrow). (B) A 6-cm-long stenosis of the jejunum (blue arrow) with significant proximal jejunum dilation (white arrow), and peritoneal adhesion that has been released (black arrow).
case_images: medi-104-e41427-g003.jpg
case_images: PMC11813066_03_medi-104-e41427-g003.jpg
case_images: F3
case_images: Gastrointestinal radiography showed a third group of contrast enhancement, indicating small bowel obstruction (Fig. 3A). Subsequently, laparoscopic exploratory surgery was performed, revealing a section of the small intestine about 6 cm long was surrounded by a greater omentum approximately 130 cm distal to the Treitz ligament, and the intestinal cavity was significantly narrowed (Fig. 3B).
case_images: PMC11813066_04
case_images: (A) Cavernous transformation of the portal vein, multiple tortuous vascular shadows around the portal vein, around the stomach and the splenic hilum (black pentagram). (B) Local intestinal wall thickened, intestinal lumen narrowed (blue arrow), and proximal small intestine dilated. (C) Gastrointestinal radiography revealed local stenosis of the ileum with a beak sign (blue arrow). (D) Gastroscopy revealed severe esophagogastric varices. (E) Extensive adhesion of bowel, mesentery, and abdominal wall was found during the operation. (F) Narrow section of the ileum (blue arrow), and proximal dilated small intestine (black arrow).
case_images: medi-104-e41427-g004.jpg
case_images: PMC11813066_04_medi-104-e41427-g004.jpg
case_images: F4
case_images: These diagnoses were confirmed by an abdominal enhanced CT scan, which also showed the lack of clear visualization of the SMV with the simultaneous formation of multiple peripheral collateral circulation (Fig. 4A). Enhanced CT of the abdomen showed narrowing of the right lower abdominal lumen with local adhesion to the peritoneum and signs of proximal small bowel intestinal obstruction (Fig. 4B). Gastrointestinal radiography showed localized stenosis of the ileum with beak sign (Fig. 4C). Gastroscopy revealed severe esophagogastric varices (Fig. 4D). The operation revealed extensive adhesion of the small intestine, greater omentum, and abdominal wall (Fig. 4E), as well as severe dilatation and edema of the small intestine. A 10 cm bowel stricture was identified 2 meters from the ligament of Treitz (Fig. 4F) and a segmental stricture jejunotomy and double jejunostomy were performed.