Adhesional small bowel obstruction

Case contributed by Ian Bickle
Diagnosis certain

Presentation

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

Patient Data

Age: 80 years
Gender: Female
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Multiple dilated small bowel loops in the central abdomen up to 3cm.

Collapsed large bowel.

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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 faeces sign in several pelvic loops.

Small volume of fluid in the pelvis.

Solid organs normal.

The shell of a mollusc

Photograph
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A photograph of a grapevine snail.

Image credit: Geierunited

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.

Image attribution

Author: Geierunited

Original file: https://commons.wikimedia.org/wiki/File:Snail.jpg

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