What are the possible options for managing post-traumatic small bowel obstruction?
Management of post traumatic small bowel obstruction is controversial. While previously, operative resection of the obstructed region was used, nowadays a trial of conservative management has also been trialed with good success.
- There is a finding suggestive of small bowel obstruction, possibly closed loop, secondary to either small bowel or mesenteric injury. Loops of small bowel in the right sided abdomen appear focally dilated and fluid filled. There is a clear transition point posteriorly on the right, beyond which the small bowel is collapsed. There is stranding and distortion of the mesentery. Some of the dilated loops of small bowel have poorly enhancing mucosa suggesting venous ischaemia.
- It is possible that the prior trauma has led to a mesenteric tear through which small bowel has herniated.
- The IVC is thin, suggesting profound volume depletion.
- New free intraperitoneal fluid is evident with layering in the pelvis.