Closed loop small bowel obstruction

Case contributed by Dr Wayland Wang

Presentation

Previous right hemicolectomy secondary to caecal volvulus, persistent seroma near anastamosis, presents with severe right periumbilical pain, guarding and rebound ?perforation ?ischaemic ?infected seroma ?cause

Patient Data

Age: 72
Gender: Male

Previous ileocolic resection and anastomosis. There are dilated loops of small bowel, measuring up to 3.3 cm. In the right side of the abdomen, there is a dilated loop of ileum that demonstrates a high grade narrowing in its efferent and its afferent loops, compatible with a closed loop obstruction (best appreciated on the coronal series). The small bowel proximal to this is dilated and the small bowel distal to this is collapsed.

There is no peritoneal free fluid or free gas. A small amount of fecal material is present in the colon.

Previous cholecystectomy. Mildly prominent common bile duct, measuring 6 mm, including minimal intrahepatic biliary prominence, which is acceptable in the postcholecystectomy state. The liver, spleen, pancreas, adrenals and stomach are unremarkable. Parapelvic cysts in both kidneys, with otherwise unremarkable kidneys. The prostate is moderately enlarged. No suspicious osseous lesions. The imaged lung bases are clear apart from negligible dependent changes.

Conclusion:

Small bowel obstruction, with a closed loop obstruction of ileum in the right-sided abdomen. The most likely underlying cause is adhesions.

No evidence of perforation.

Case Discussion

Closed loop small bowel obstruction is considered a surgical emergency, as the "closed" loop is at high risk of strangulation.

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Case information

rID: 59227
Published: 27th Mar 2018
Last edited: 28th Mar 2018
Inclusion in quiz mode: Included

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