Presentation
Constipation and periumbilical abdominal pain for 2 days. No history of previous surgery.
Patient Data
A cluster of dilated small bowels in the mid to lower abdomen with two adjacent transition points leading in and out of this cluster at the mid-abdomen at the level of the umbilicus. An associated mild swirling of the mesenteric vessels at this region with mesenteric edema. Proximally, the small bowels are mildly dilated with wall thickening. Distally, the rest of the small bowels are collapsed. Bowel enhancement is still preserved. Moderate ascites with evidence of interloop fluid. No pneumoperitoneum or intramural gas.
These findings are suggestive of a closed-loop small bowel obstruction with two adjacent transition points at the mid-abdomen and moderate ascites. No evidence of bowel ischemia or perforation.
The yellow arrows demonstrate the two adjacent transition points.
Case Discussion
The usual causes of closed-loop small bowel obstructions are adhesions, volvulus, or hernia.
In this patient, the cause of obstruction was due to a congenital adhesion band, causing approximately 70 cm of small bowel to be entrapped. The entrapped bowels were congested and dilated; however still viable. 300 ml of hemorrhagic ascites drained.
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