Closed loop small bowel obstruction - adhesive band with a C-shaped loop
Presentation
Abdominal pain.
Patient Data
Dilated, fluid-filled mid small bowel leading into a focal, swirling C-loop with mildly thickened wall in the right lower abdomen with two adjacent transition points into and out of the loop. Distal small bowel is decompressed. Pessary.
Annotation of C-shaped loop on coronal images.
Case Discussion
Classic "C-loop" configuration indicating a closed-loop small bowel obstruction. Closed loop obstructions with dilated upstream small bowel can be particularly challenging because unless you run the small bowel, you may not detect that there are two transition points. In this case, the two transition points into and out of the closed "C-loop" in the RLQ are best seen on coronal images (although sagittal are also worth reviewing to help understand the anatomy). In challenging bowel cases, it is essential to review all planes to help you understand the anatomy and boost your diagnostic confidence. This patient proceeded to surgery and a closed loop obstruction due to adhesive band with small bowel ischemia was identified, resulting in resection of small bowel and prolonged postoperative course.
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