Presentation
Previous history of abdominal gunshot injury with subsequent stoma placement 1 year ago. Now complaining if vomiting and abdominal pain for 3 days.
Patient Data
Multiple air-fluid levels within the central abdomen. No pneumoperitoneum or portomesenteric gas.
Radio-opaque in the left upper quadrant from retained bullet shrapnel.
Left-sided ileostomy with no parastomal hernia or strangulation. Small bowel obstruction with dilated proximal bowel loops and collapsed distal loops. Coronal images show the swirling of vessels and mesentery around a coffee-bean-shaped loop of the bowel. This represents a segment of a loop of the bowel that has been obstructed at two points. The large bowel is collapsed. No portomesentric gas.
Retained bullet shrapnel is noted within the posterior lower chest
Case Discussion
The case demonstrates a segment of small bowel obstruction with swirling of mesenteric vessels and fat in keeping with closed-loop obstruction. The patient had surgery with confirmation of the small bowel obstruction.
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