Closed loop small bowel obstruction
Previous colostomy for colorectal malignancy. Distended abdomen and vomiting.
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Left iliac fossa colostomy.
The small bowel is moderately dilated and fluided filled down the site of a small left inferior anterior abdominal wall hernia.
The hernia contains a very small segment ('knuckle') of ileum with dilatation of both the afferent and efferent loops.
No free fluid or free gas.
The solid organs are normal.
In closed loop bowel obstruction two points along the course of a segment of bowel are obstructed at a single location, such as a hernia, thus forming a closed loop. Both the efferent and afferent loops will be dilated, as opposed to the single site cut off of typical bowel obstructions.
They account for a small percentage of bowel obstructions and is specific entity of small bowel obstruction. There is a high chance of ischaemia in the closed off segment of bowel.
This case was proven at surgery.