Adhesional small bowel obstruction

Case contributed by Ian Bickle
Diagnosis certain


Two days absolute constipation. Distended painful abdomen. Previous surgery.

Patient Data

Age: 80 years
Gender: Female

Multiple dilated small bowel loops in the central abdomen up to 3cm.

Collapsed large bowel.

NG tube tip in a distended fluid filled stomach.

The small bowel is dilated and fluid filled down to a transition point in the proximal ileum to the right of the midline of the pelvis, at the site of a vascular whirl.  Small bowel feces sign in several pelvic loops.

Small volume of fluid in the pelvis.

Solid organs normal.

The shell of a mollusc


Case Discussion

The plain radiograph sign showing the dilated small bowel has a mollusc like appearance.   

I am not aware of a snail sign, but if there was one it should be this.

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