Closed loop small bowel obstruction
Severe abdominal pain and vomiting. The patient is a known case of sigmoid colon cancer post sigmoidectomy and hysterectomy.
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There is a markedly dilated and twisted U-shaped loop of ileum seen in the pelvis with the twisting point located deeply in the pelvis posterosuperior to the urinary bladder. Tapering of the small bowel loops at the point of obstruction (double beak sign) is noted. The small bowel loops are dilated proximal to the point of obstruction and collapsed distal to it.
The mesenteric vessels supplying the mentioned loop showed no contrast opacification, and there is markedly reduced wall enhancement in the obstructed/closed ileal loop compatible with ischemia/strangulation. No definite pneumatosis intestinalis, portal vein gas or pneumoperitoneum.
Mild ascites is seen mainly around the closed loop.
No definite masses or enlarged lymph nodes.
There are two calcified gall bladder stones. The CBD is mildly dilated proximally with distal tapering.
This patient was sent urgently to the operation theater for laparotomy. Intraoperatively, a small defect in the mesentery was discovered and closed-loop obstruction was confirmed. A strangulated segment of ileum was resected. The patient did well after the surgery.
The final diagnosis was closed-loop small bowel obstruction and strangulation due to a small defect in the mesentery.