Presentation
Right upper quadrant pain. Previous cholecystectomy.
Patient Data
The duodenum and proximal jejunum are dilated, with a transition point seen in the left periumbilical region. A loop of jejunum in this region has a mildly thickened wall that is hypoenhancing. Small volume of free fluid in the pelvis.
Previous cholecystectomy. The liver, spleen, pancreas, kidneys and adrenal glands are unremarkable. No suspicious bony lesion. The imaged lung bases are clear.
Conclusion:
Mechanical small bowel obstruction with a transition point seen in the left periumbilical region. The bowel in this region has an appearance that is concerning for ischemia, and closed loop obstruction should be considered.
Case Discussion
The patient was taken to theater and the diagnosis of closed loop obstruction with hypoperfused small bowel confirmed.
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