Presentation
Abdominal pain. History of enterostomy.
Patient Data
Mild dilation of mid-small bowel leading into an abnormal cluster of small bowel in the lower abdomen/pelvis which has asymmetric edema, clustered appearance with a radial orientation of the vessels, and U/C-shape on coronal images. These loops are slightly hypo-enhancing. There are transitions in and out of this loop next to each other with sharp angulation/beaking in the right lower quadrant. Right lower quadrant ostomy. Mild free ascites.
Case Discussion
Surgery confirmed closed loop obstruction and resected 60 cm of ischemic small bowel. It is challenging to find the transition into and out of the closed loop as they are tightly packed into the right lower quadrant, but you can identify them if you carefully follow the closed loop in each direction toward the entrance/exit. The closed loop segment is quite characteristic with the inverted U-shape on coronal images, asymmetric edema, and radial orientation of the vessels toward the transition points.
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