Presentation
History of multiple laparotomies with incisional hernia. Presented with vomiting and abdominal pain.
Patient Data
Wide neck incisional hernia between the rectus muscle extending from the epigastric to umbilical region, containing loops of small bowel and its mesentery. Segmental loops of dilated small bowel seen within the hernia sac and upper abdomen with two transition points adjacent to each other at the hernia neck. Proximal jejunum and duodenum are also dilated. Minimal interloop fluid. Bowel enhancement is still preserved. No significant bowel wall thickening. No intramural gas or pneumoperitoneum.
These findings are suggestive of a closed loop small bowel obstruction at the region of the hernia neck. No evidence of bowel ischemia or perforation.
Unchanged segment VIII liver hemangioma (ultrasound and multiphase CT liver done previously).
The blue arrows demonstrate the two transition points.
Case Discussion
Closed loop small bowel obstructions are usually due to adhesions, hernia or volvulus.
This patient has small bowel obstruction with dilated loops of small bowel seen within the hernia sac and also within the abdominal cavity. The two transition points adjacent to each other is at the region of the hernia neck, however as the hernia neck is large, this is probably caused by adhesions. Collapsed loops of small bowel are still seen within the hernia sac, making it less likely that the obstruction is due to the hernia itself.
The jejunal and duodenal segments upstream from the proximal point of obstruction are distended in keeping with supralesional syndrome.
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