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Closed loop small bowel obstruction

Case contributed by Hoe Han Guan , 8 Jul 2022
Diagnosis certain
Changed by Henry Knipe, 12 Jul 2022
Disclosures - updated 6 Apr 2022:
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Updates to Case Attributes

Title was changed:
Stercoral colitis with closed loopsClosed loop small bowel obstruction
Body was changed:

Closed loopThis a case of a closed-loop small bowel obstruction. The reduced bowel wall enhancement at this segment of small bowel segments and ascites are suspicious of bowel ischaemia.

Chronic rectal faecal impaction.  Due to and gross distension of colon by impacted faeces, the diagnosis of stercoral colitis should be considered (Although(although it is commonly encountered within elderly patientpatients, it can present in young patientpatients who have neurologic or muscular disorders).

PatientThis patient has previousa history of extended left hemicolectomy during infancy with primary anastomosis. The intestinal obstruction is likely due to adhesion.

Intra-operatively, a closed loop-loop obstruction secondary to adhesion bands with a short segment of small bowel ischaemia resection. Ileostomyresected and an ileostomy created.

  • -<p>Closed loop small bowel obstruction. The reduced bowel wall enhancement at this segment of small bowel segments and ascites are suspicious of bowel ischaemia.</p><p>Chronic faecal impaction.  Due to gross distension of colon by impacted faeces, the diagnosis of <a href="/articles/stercoral-colitis">stercoral colitis</a> should be considered (Although it is commonly encountered with elderly patient, it can present in young patient who have neurologic or muscular disorders).</p><p>Patient has previous history of extended left hemicolectomy during infancy with primary anastomosis. The intestinal obstruction is likely due to adhesion.</p><p>Intra-operatively, closed loop obstruction secondary to adhesion bands with short segment of small bowel ischaemia resection. Ileostomy created.</p>
  • +<p>This a case of a <a title="Closed loop obstruction" href="/articles/closed-loop-obstruction">closed-loop small bowel obstruction</a>. The reduced bowel wall enhancement at this segment of small bowel segments and ascites are suspicious of <a title="Small bowel ischaemia" href="/articles/small-bowel-ischaemia">bowel ischaemia</a>.</p><p>Chronic rectal <a title="Faecal impaction" href="/articles/faecal-impaction">faecal impaction</a> and gross distension, the diagnosis of <a href="/articles/stercoral-colitis">stercoral colitis</a> should be considered (although it is commonly encountered in elderly patients, it can present in young patients who have neurologic or muscular disorders).</p><p>This patient has a history of extended left hemicolectomy during infancy with primary anastomosis. The intestinal obstruction is likely due to adhesion. Intra-operatively a closed-loop obstruction secondary to adhesion bands with a short segment of small bowel ischaemia resected and an ileostomy created.</p>
Presentation was changed:
Severe abdominal pain and distension for 4 days with backgrounda history of abdominal surgery.

Systems changed:

  • Paediatrics

Updates to Link Attributes

Title was removed:
Stercoral colitis with closed loops obstruction
Type was removed.
Visible was set to .

Updates to Link Attributes

Title was removed:
Stercoral colitis with closed loop obstruction
Type was removed.
Visible was set to .

Updates to Primarylink Attributes

Updates to Study Attributes

Findings was changed:

Most left sided-sided colon is absent due to previous surgical resection. The right sided-sided colon and rectum are grossly dilated and filled with a large amount of impacted faeces. The largest diameter of the colon measures up to 10.3 cm. 

Abnormal U and C shape-shape small bowel loops dilatation at the left lumbar region, with a diameter up to 4.0cm. These segments of dilated ileum have reduced bowel wall enhancement compared to the normal calibercalibre and well enhanced-enhanced jejunum.No intramural gas, pneumoperitoneum or portal venous gas. Moderate ascites.

Mesenteric infiltration/fluid with mesentery lymphadenopathy noted.

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