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AJR Teaching File: Acute Abdominal Pain After Combined Kidney and Pancreas Transplantation

Frederick Chen1 and Alvin C. Silva1

1 Both authors: Department of Diagnostic Radiology, Mayo Clinic Scottsdale, 13400 E Shea Blvd., Scottsdale, AZ 85259.


Figure 1
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  		Fig. 1A —39-year-old man with omental infarction who presented with acute abdominal pain and low-grade fever 1 week after receiving combined kidney and pancreas transplant. Axial unenhanced CT scan shows thickening and infiltration of omentum (arrow) anterior and lateral to descending colon (arrowhead). Note lack of thickening in adjacent colon wall.

 

Figure 2
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  		Fig. 1B —39-year-old man with omental infarction who presented with acute abdominal pain and low-grade fever 1 week after receiving combined kidney and pancreas transplant. Axial unenhanced CT scan caudal to A shows significantly more infiltration of omentum (arrow).

 

Figure 3
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  		Fig. 1C —39-year-old man with omental infarction who presented with acute abdominal pain and low-grade fever 1 week after receiving combined kidney and pancreas transplant. Coronal unenhanced CT scan shows extension of abnormal omentum (long arrows) from level of splenic flexure of colon (arrowhead) to above level of renal transplant (short arrow). Note associated mass effect displacing colon to the right.

 

Figure 4
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  		Fig. 2 —72-year-old afebrile woman with epiploic appendagitis who presented with acute left lower quadrant pain and laboratory values within normal ranges. Axial contrast-enhanced CT scan at level of junction of descending and sigmoid colon shows oval paracolonic fatty mass with hyperattenuating rim (arrow) that is characteristic of epiploic appendagitis, despite presence of diverticula (arrowheads). In addition, this patient's clinical presentation is not typical of someone with diverticulitis. In a patient with no prior surgery, location and appearance would also preclude segmental omental infarction.

 

Figure 5
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  		Fig. 3 —67-year-old febrile man with acute diverticulitis who presented with left lower quadrant pain, leukocytosis, and known history of diverticulosis. Axial contrast-enhanced CT scan at level of distal descending colon shows abnormal infiltration of pericolonic fat and associated punctate gas collections (long arrow). Note abnormal thickening of colon wall (short arrow) adjacent to pericolonic inflammatory changes.

 

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