Presentation
Elderly female complaining of diffuse abdominal pain.
Patient Data
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Dilated distal small bowel, in keeping with small bowel obstruction.
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Dilated fluid filled small bowel loops, down to a transition point in left groin. A 'knuckle' of small bowel is incarcerated in a small left femoral hernia ( not detectable on clinical examination).
Foci of free air in the abdomen in keeping with perforated small bowel.
Case Discussion
Small bowel obstruction is common. One of the more common causes is due to an abdominal wall hernia.
This is one of the very satisfying findings to aid the surgeon and the value of the CT scan, along with confirming the diagnosis and looking for a visceral perforation.
This patient underwent emergency surgery, confirming all of the above.