Closed loop small bowel obstruction

Case contributed by Heather Pascoe
Diagnosis certain


? Bowel obstruction. Several previous intra-abdominal surgeries. Renal transplant patient. Vomiting and absolute constipation.

Patient Data

Age: 70 years
Gender: Female

There is a thick walled poorly enhancing loop of small bowel in the pelvis on the left with 2 transisition points and surrounding fat stranding. The small bowel proximally is dilated and small bowel distally is collapsed. There is suture material in the cecum. The large bowel is not dilated.

Moderate volume ascites. No free gas or pneumatosis. Normal lung bases. Degenerative bony change. 

Case Discussion

The patient proceeded to surgery immediately. Adhesions were found and ileum was resected.

PATHOLOGY: Macroscopically the mucosal folds were attenuated and the mucosa dusky with exudate. The bowel wall was up to 7mm thick and the serosa was dark brown to grey. Microscopically the sections showed ulceration and hemorrhage. No necrosis. Abundant acute inflammation. The submucosa was edematous with inflammatory changes. The blood vessels were congested. Diagnosis: Acute ischemia with hemorrhage. The resection margins are viable.

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