Dilated small bowel (suspected bowel obstruction)

Case contributed by Mohammad walid Ahmad Amin

Presentation

The patient has a history of jejunal atresia corrected by resection of the atretic loop with jejunojejunal anastomosis. She presented to the ER after two days of constipation, vomiting, and abdominal pain.

Patient Data

Age: 10 years
Gender: Female

Markedly dilated stomach, duodenum and jejunum.

At the level of pelvis, a jejuno-jejunal anastomosis is noted.

The first image was done before the fluoroscope, there is residual rectal contrast from the CT and an NG tube is in situ.

The second image was taken 30 minutes after the administration of contrast through the NG tube for a follow-through study. 

All images show markedly enlarged small bowel loop with prominent valvulae conniventes mainly in the left side of the abdomen suggesting jejunal dilation.

Follow-through study shows markedly dilated jejunal loops. The contrast reaches the colon after 2 hours, excluding complete bowel obstruction. 

Case Discussion

The patient has a history of jejunal atresia corrected by resection of the atretic loop and jejuno-jejunal anastomosis, which increases the risk of intestinal obstruction. 

Note that the appearance of the jejunum in the follow-through images is similar to the hidebound appearance of bowel in scleroderma patients.   

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