Scleroderma

In involvement of the small bowel by scleroderma, muscle atrophy results in atonicity and dilatation. Replacement of the atrophied muscle by collagen occurs in a patchy fashion, with perivascular accumulation in the submucosa. Accordion-pleating of the mucosal folds occurs in the face of luminal dilatation, resulting in a typical "hidebound" appearance.11 The individual folds are not thickened. At sites without sclerosis, areas of more normal or atrophic bowel may bulge out between the text continues on page 650

Intestinal Scleroderma

Fig. 14—15. Acquired diverticula of the small intestine.

Multiple diverticula (Div) project from the mesenteric borders of jejunal loops.

(Reproduced from Meyers.2)

Fig. 14—15. Acquired diverticula of the small intestine.

Multiple diverticula (Div) project from the mesenteric borders of jejunal loops.

(Reproduced from Meyers.2)

Fig. 14—16. Diverticulosis of the small bowel.

Pressure spot film localizes the diverticula (Div) as specifically arising from the concave, mesenteric border of a jejunal loop. (Reproduced from Meyers.2)

Fig. 14—16. Diverticulosis of the small bowel.

Pressure spot film localizes the diverticula (Div) as specifically arising from the concave, mesenteric border of a jejunal loop. (Reproduced from Meyers.2)

Meckels Diverticulum Intraoperative

Fig. 14—17. Diverticulosis of the terminal ileum.

Pressure spot film shows the diverticula arising from the mesenteric border. A few cecal diverticula are also present.

Fig. 14-18. Vitelline artery supply to Meckel's diverticulum.

Intraoperative selective injection of methylene blue into the vitelline artery stains the artery (arrows) and Meckel's diverticulum (MD) arising from the antimes-enteric border of the ileum. There is no staining of the ileum and mesentery.

(Reproduced from Okazaki et al.7)

Fig. 14-18. Vitelline artery supply to Meckel's diverticulum.

Intraoperative selective injection of methylene blue into the vitelline artery stains the artery (arrows) and Meckel's diverticulum (MD) arising from the antimes-enteric border of the ileum. There is no staining of the ileum and mesentery.

(Reproduced from Okazaki et al.7)

Meckels Diverticulum Intraoperative

Fig. 14-19. Meckel's diverticulum.

The saccule (MD) extends from the antimesenteric convex border of a terminal ileal loop. (The filling defects within it in this instance are secondary to calculus formation.) (Reproduced from Meyers.2)

Fig. 14-19. Meckel's diverticulum.

The saccule (MD) extends from the antimesenteric convex border of a terminal ileal loop. (The filling defects within it in this instance are secondary to calculus formation.) (Reproduced from Meyers.2)

Meckels Diverticulum Radiology

Fig. 14-20. Meckel's diverticulum.

The large saccule (MD) extends from the antimesenteric border of a terminal ileal loop, which it indents in the right lower quadrant of the abdomen. (Reproduced from Meyers.2)

Fig. 14-20. Meckel's diverticulum.

The large saccule (MD) extends from the antimesenteric border of a terminal ileal loop, which it indents in the right lower quadrant of the abdomen. (Reproduced from Meyers.2)

Fig. 14—21. Meckel's diverticulum in an 8-year-old boy with cramping pain and melena.

Enteroclysis demonstrates a large Meckel's diverticulum arising from the antimesenteric border of distal ileum showing typical junctional fold pattern (arrowhead), with large ulceration in an area of ectopic gastric mucosa (arrow). TI = terminal ileum; C = cecum. (Reproduced from Maglinte et al. )

Fig. 14—22. Meckel's diverticulum.

CT demonstrates a 5-cm Meckel's diverticulum (MD) attached to the antimesenteric side of the ileum. The fibrous remnant of the vitelline duct extends between the diverticulum and the umbilical region. (Courtesy of Gary Ghahremani, M.D., Evanston, IL.)

Fig. 14—22. Meckel's diverticulum.

CT demonstrates a 5-cm Meckel's diverticulum (MD) attached to the antimesenteric side of the ileum. The fibrous remnant of the vitelline duct extends between the diverticulum and the umbilical region. (Courtesy of Gary Ghahremani, M.D., Evanston, IL.)

Fig. 14—23. Meckel's diverticulum.

The opacified saccule (MD) attached to the antimesenteric border of a midileal loop (curved arrow) occupies the subhepatic region in the right upper quadrant. (Courtesy of Gary Ghahremani, M.D., Evanston, IL.)

tethered sections, producing sacculations or pseudodi-verticula13 (Fig. 14-24). In distinction to true divertic-ula, these are wide-mouthed and occur on the anti-mesenteric border. Sacculations are typical of scleroderma, though more commonly seen in the colon than in the small bowel.

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