Presentation
Severe abdominal pain.
Patient Data
Isolated segment of dilated small bowel with mesenteric edema. Two adjacent transition points in the left lower abdomen indicating the obstruction at two points (a closed loop), best seen on the coronal images. Short segment of dilated small bowel which appears to be leading into the closed loop segments, with otherwise normal caliber upstream bowel. Moderate gastric distention.
No pneumatosis or free air.
Circle indicates the site of obstruction of the small bowel as it ENTERS and EXITS the closed loop. Notice they are right next to each other, as is most often the case.
Case Discussion
Patient was initially managed conservatively until there was clinical decompensation and a dramatic rise in lactate. In the OR, 80 cm of infarcted small bowel was resected.
This case serves as a sobering reminder of the importance of timely diagnosis of closed loop obstruction!
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