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Adhesional small bowel obstruction

Case contributed by Ian Bickle
Diagnosis certain

Presentation

RTA with laparotomy several years prior. A short history of a distended abdomen, nausea and now vomiting.

Patient Data

Age: 45 years
Gender: Male

Moderately dilated fluid-filled small bowel down to the level of the proximal ileum (in the left iliac fossa) where there is an abrupt transition point.

The mid and distal ileum is collapsed.  Normal caliber large bowel.

A small volume of free fluid in the upper abdomen and pelvis.  No free gas. 

Fatty paraumbilical hernia.

Solid organs of the upper abdomen normal.

Case Discussion

A good example of an adhesional small bowel obstruction with a well identified, traceable transition point and absence of an alternative cause like a mass, hernia or intussusception.

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