Presentation
Severe abdominal pain and distension with vomiting. Past history of hysterectomy and appendicectomy.
Patient Data
The small bowel loops are dilated and there are two transition points at the terminal ileum, resulting in a strangulated segment (closed loop) with a thickened and engorged wall.
The colon is collapsed.
Mild ascites is noted.
No evidence of perforation.
White arrows: afferent/proximal transition point
Green arrows: efferent/distal transition point
Red circle: strangulated/closed loop
Case Discussion
This case presents classic findings of closed loop obstruction with two transition points and a strangulated loop in between. In this case, the most likely cause of closed loop obstruction is postoperative adhesions resulting from a previous appendicectomy. Other causes include hernia and volvulus.
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