Presentation
Abdominal pain, nausea, vomiting.
Patient Data
Diffuse dilation of the proximal small bowel, with abrupt transition in a short segment of small bowel thickening and relatively increased enhancement with slight mucosal irregularity within the central pelvis, with a nearly "apple core" appearance on sagittal images. The distal small bowel beyond this is decompressed. The colon is relatively normal in caliber. No ascites or peritoneal nodules. Subtle indeterminate lesion in hepatic segment 7/8.
Case Discussion
In this patient without prior surgical history, the new diagnosis of small bowel obstruction may increase concern for potential malignant cause. In this case, there is a transition point within area of relatively increased thickening and enhancement of the small bowel, which was resected at the time of surgery and determined to be a small bowel adenocarcinoma. In this case, reviewing the coronal and sagittal images and scrutinizing the transition point should raise concern of a potentially malignant cause, as typically adhesive disease does not cause such focal/segmental small bowel thickening or increased enhancement.
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