Presentation
Abdominal pain. No prior history of surgery provided. Surgeon's indication, "It's pain that doesn't fit with anything."
Patient Data
Non contrast due to prior allergy.
The proximal small bowel is malrotated in the left flank, but without reversal (whirl sign) of the vasculature. A segment of bowel is coiled in a 'snail-like' configuration, with intense mesenteric inflammatory change.
Short segment of associated thickened distal descending colon.
Fluid in the pelvis and upper abdomen. No free gas.
Basal calcified pleural plaques.
Case Discussion
This is an uncommon, but a very nice example, of a small bowel obstruction due to an internal hernia.
In fact, the segment of small bowel contained within the internal hernia was infarcted at the time of laparotomy.
Internal hernias can be difficult to diagnosis, even on CT, but this is an excellent example.