CT A/P with portal venous phase contrast
There are multiple dilated and fluid-filled loops of small bowel, in keeping with obstruction. In the mid-small bowel, a closed-loop segment is demonstrated, better appreciated on the coronal view. Abrupt narrowing is present at both ends of this short loop, which has a C-shape on the coronal images. The wall of this segment enhances less than the remaining small bowel, indicating bowel ischaemia. A small blind-ending sac is noted to arise just posterior to the abruptly narrowed bowel, the nature of this is unclear. The small bowel loops downstream to the transition point are collapsed. There is free intraperitoneal fluid. No pneumoperitoneum.
Diagnosis: Mechanical (closed loop) bowel obstruction with ischaemia.