Closed loop small bowel obstruction due to adhesive band - U-shaped loop
Presentation
Abdominal pain.
Patient Data
Isolated dilated, fluid-filled segment of small bowel in the pelvis with mild interloop edema. Small bowel wall is not thickened or hypoenhancing. Segment is caused by two adjacent transition points characterized by sharp angulation. Upstream bowel only minimally dilated just before the proximal transition. No other acute findings.
Annotated images
Annotated images highlight proximal and distal transition points.
Case Discussion
This patient had a confusing (and potentially misleading) clinical presentation of leukocytosis, normal lactate, and a non-concerning physical examination. The radiologist appropriately diagnosed a closed-loop obstruction, and this patient proceeded to the OR where they found "in the mid jejunum, a segment of red, injected, and dilated bowel that appeared threatened and was adherent to a dense adhesion deep in the pelvis...Once entering the abdomen, we were able to identify a single thick adhesive band which was causing the closed-loop obstruction."
The features that should immediately raise the concern of a closed-loop:
- isolated, dilated loop of small bowel
- U-shaped loop on coronal reformats
- two adjacent transition points into and out of the closed-loop segment
The transition into the closed-loop is somewhat difficult to see on axial and coronal, but well delineated on sagittal (see annotated image). The transition out of the closed-loop is easiest to see on coronal (annotated image). When trying to sort out a CLO, you must use all of your reformats! The sharp angulation/buckled appearance of the small bowel is typical for an adhesive band as the cause.
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