This 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 ischemia.

Chronic rectal fecal impaction and gross distension, the diagnosis of stercoral colitis should be considered (although it is commonly encountered in elderly patients, it can present in young patients who have neurologic or muscular disorders).

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 ischemia resected and an ileostomy created.