Presentation
Right lower abdominal pain. Rule out appendicitis vs. ovarian cyst. White cell count elevated.
Patient Data
Abnormal bowel gas pattern with dilated small bowel loops centrally in the abdomen and multiple short air fluid levels at erect imaging. Granular fecal material in the colon.
Long segment of abnormal dilatation of the small bowel with high grade caliber change in the left adnexum where there are two adjacent short segments of high grade narrowing of the distal ileum immediately inferior to the left Fallopian tube. The terminal ileum distal to this site is completely collapsed.
No signs of perforation. The appendix is normal.
Case Discussion
AXR findings consistent with incomplete small bowel obstruction. CT shows high grade small bowel obstruction, likely due to an internal hernia at the left broad ligament. An incarcerated distal ileum left broad ligament hernia was confirmed at surgery.
With thanks to Drs. F. Melonas, J. Alves and D. Nothling.
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