Presentation
Acute, severe colicky abdominal pain. Distended, rigid, guarded.
Patient Data
Proximal closed loop small bowel obstruction in the left lower quadrant, involving the jejunum and ileum. The distal ileum is collapsed beyond the distal transition point.
The small bowel within the closed loop is fluid-filled, with extensive mesenteric stranding. Mild mural thickening, however, no evidence of pneumatosis coli.
No portal venous gas. No pneumoperitoneum.
Moderate volume free fluid within the pelvis.
Appendicectomy and cholecystectomy.
Diffuse hepatic steatosis.
Case Discussion
This case represents a closed loop small bowel obstruction secondary to adhesions.
This patient proceeded to the operating theatre shortly after their imaging. The operation record stated "Closed loop small bowel obstruction with two transition points. Spontaneously detached. Bowel wall haemorrhagic only with no necrosis. No resection required".
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