Adhesive small bowel obstruction

Case contributed by Mohamed Saber


Abdominal pain and vomiting for three days. History of complicated right inguinal hernia a few years ago.

Patient Data

Age: 40 years
Gender: Male

Mild to moderate dilatation of small bowel loops mainly involving the distal jejunal and proximal ileal loops measure up to 3.5 cm mean diameter seen distended with fluid and gas contents with multiple gas/fluid levels.

The distal ileal loops appear not dilated with visualized two transitional collapsed ileal segments related to each other.

Laparoscopic photos


The laparoscopic assessment was done three days later and showed progressive small bowel dilatation, multiple adhesions, and yellowish serous transudate.

Case Discussion

The diagnosis was suspected in CT depending on the pattern of the transitional points and past history of complicated right inguinal hernia surgery. Conservative treatment was failed, so a laparoscopic assessment was done followed by laparotomy. Adhesiolysis was done and the obstruction was relieved with a good postoperative outcome.

The water-soluble contrast challenge is a good technique that could be valuable in such cases.


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