Presentation
Elderly patient on medical ward with abdominal pain, AF and a metabolic acidosis.
Patient Data
Multiple loops of small bowel with feculent type material within.
Dilated non-enhancing small bowel loops in the midline of the lower abdomen/pelvis.
Closed loops obstruction - transition points of afferent and efferent loops - suggesting an adhesional obstruction.
Three classical signs
1. Closed loop obstruction
2. Small bowel feces sign
3. Non-enhancing small bowel - with adjacent normally enhancing bowel, illustrating the sign beautifully, indicated ischemic bowel.
The band adhesion is shown underneath the surgical instrument - the cause of the obstruction.
The resultant large length of ischemic small bowel is shown prior to resection.
Case Discussion
Ischemic bowel is a relatively frequent presentation to general surgery.
A strong clinical suspicion assists the radiologist in making a confident diagnosis - the signs can be variable and range from subtle to frank.
This case shows a classic example of a closed loop obstruction from a adhesion, with resultant necrotic bowel.
This is evidenced by a long section of non enhancing bowel and the small bowel faeces sign.