Presentation
Periumbilical pain, nausea.
Patient Data
Dilated small bowel loops, air-fluid levels.
No gas or feces visible in the colon. Feces in the rectum.
Radiographic picture of small bowel obstruction.
Nasogastric tube in the stomach.
The entire small bowel is dilated up to 4.1 cm due to an ileocecal intussusception. The colon is collapsed.
Moderate amount of free intraperitoneal fluid.
Case Discussion
The patient was rushed to the OR, where an ileocecal resection was performed, followed by an ileo-ascending colon anastomosis.
Pathology:
Ileocecum (resection):
Small bowel intussusception due to a pedunculated intraluminal necrotic polyp, of probably inflammatory type. Signs of ischemic necrosis of the small bowel involving the entire intestinal wall thickness with edema, blood vessel congestion, and fresh hemorrhages. Proximal and distal resection margins without remarkable changes. The remaining preserved small intestine and cecum are free of pathological changes. No lymph nodes were seen in the peri-intestinal fat.
Appendix: Coprostasis.