Adhesional small bowel obstruction

Case contributed by Dr Ian Bickle

Presentation

Gynecological surgery many years prior. Distended abdomen.

Patient Data

Age: 60 years
Gender: Female

NG tube in situ.

Severely dilated fluid filled small bowel to within 10cm of the terminal ileum, where there is an abrupt cut off.

The terminal ileum is collapsed.

The large bowel is non-distended.

Trace of pelvic free fluid. No free gas.

Solid organs normal.

 

Annotated image

The red arrows indicate the transition point.

Dilated fluid filled small bowel above and a collapsed terminal ileum.

No mass or hernia evident as cause for obstruction.

Photo

Surgical notes concurring with the CT report.  The transition point at surgery was 10cm from the ileocecal valve.

Case Discussion

Small bowel obstruction is a common surgical presentation.

CT is the first line investigation on many levels.

The commonest cause of obstruction is adhesions.  This is something radiologists cannot directly see on CT, but the indirect signs are indicative.

The is a textbook appearance of an adhesional related transition point.

It is always of educational merit and professionally rewarding to follow up operative findings of reported studies.

 

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Case information

rID: 48397
Published: 8th Oct 2016
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included

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