CT
Presence of lower midline incisional laparotomy scar from the previous total abdominal hysterectomy surgery.
Wide neck of incisional hernia with small bowel loops within the hernia sac.
"Double beak sign" noted at the hernia neck where two sites of tapering bowel loops indicate the point of obstruction. The small bowel loops distant to the hernia neck (point of obstruction) is not dilated as there is air-filled tract in keeping with perforated site. A large collection located adjacent to this perforated site within the hernia sac.
Proximal small bowel loops prior to entry into the incisional hernia are grossly dilated. No intramural gas, portal venous gas or pneumoperitoneum.
Bowel wall and mucosa enhancement preserved.
Significant amount of subcutaneous gas over the lower abdomen, predominantly at the left side.
Fat streakiness and abdominal skin thickening denote the on-going inflammatory/infective process.
Large colon and distal ileum are collapsed.