Closed loop small bowel obstruction due to trans-omental herniation
Right iliac fossa pain. ?Appendicitis
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Moderate amount of free fluid throughout the abdomen, greatest within the pelvis and right paracolic gutter/perihepatic region. There is the impression of a closed loop obstructing point involving a segment of distal small bowel to the right of midline. The mesentery of this loop of small bowel is markedly oedematous and congested, and some degree of ischaemia is thought likely. No free intraperitoneal gas seen. Normal appearance of liver, spleen, gallbladder, pancreas, adrenals and kidneys. Incidental note of 13 mm simple hepatic cyst within the left lobe. 18 mm simple right parapelvic renal cyst and 10 mm renal cyst within the right inferior pole.
This case of closed loop small bowel obstruction was found to be due to transomental herniation at operation. Although the mesenteric vascular congestion and the amount of free fluid was concerning on CT for ischaemia, the bowel was not ischaemic at operation and the patient had an uneventful recovery without the need for bowel resection.