Presentation
Worsening abdominal pain. History of remote liver transplantation.
Patient Data
Isolated loop of dilated and obstructed proximal small bowel with closed loop configuration. Two adjacent transition points entering and exiting the closed loop, best seen on coronal reformats. The clustering of the small bowel loops suggests internal hernia. Mesenteric edema.
Liver transplant. SMV jump graft to the transplant portal vein appears compressed, twisted, and distorted.
Circle indicates the site of the small bowel ENTERING and EXITING the closed loop into the internal hernia sac.
Case Discussion
Closed loop obstruction due to internal hernia from a defect created from her SMV jump graft to the transplant portal vein (remote history of liver transplantation). Notice how the graft is hard to see because it is twisted and compressed, further supporting internal hernia.
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