Presentation
Abdominal pain
Patient Data
CT findings show dilated loops of the small bowel with gas-fluid levels, the transitions are at two adjacent points along the course of dilated bowel (double beak sign at two sites of fusiform tapering).
The bowel loops have a strange arrangement: The clump of dilated loops concentrates at the periumbilical region with the mesenteric vessels towards a central point.
The wall bowel has a normal enhancement but mesenteric edema was suggestive of ischemic bowel.
The whirl sign can be seen on coronal reconstruction.
Intraperitoneal free fluid in the recto-vesical pouch, the left iliac fossa, and surrounding the liver.
CT findings demonstrate the typical features of closed-loop obstruction in SBO.
Pink arrow: proximal/afferent loop
Green arrow: closed-loop (strangulated loop)
Blue arrow: distal/efferent loop
Red circles: Two-point of obstruction
Orange arrows: a clump of bowel loops
Purple star: mesenteric edema
Case Discussion
This case is a typical illustration of closed-loop obstruction which is a specific type of bowel obstruction.
Closed-loop obstructions are at higher risk than non-closed loop obstructions for intestinal necrosis and perforation because of strangulated vessels and large distended bowel. The commonest cause is adhesion, and the internal hernia is the second cause.
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