Mechanical small bowel obstruction

Case contributed by Dr Craig Hacking

Presentation

Abdominal pain and distension.

Patient Data

Age: 40 years
Gender: Female
X-ray

No evidence of pneumoperitoneum. There are several central loops of small bowel which are moderately dilated and demonstrate air fluid levels on the erect projection suggesting a small bowel obstruction. No gas or faeces seen in the large bowel suggesting it is collapsed distal to the point of obstruction. No bowel wall thickening appreciated. The hernial orifices are not visualised

There is small bowel dilatation and multiple air fluid levels with a transition point in the right iliac fossa in keeping with mechanical small bowel obstruction. The terminal ileum beyond this transition point is stenotic, with wall thickening and adjacent fat stranding in keeping with terminal ileitis. Small bowel just proximal to the transition point contains faeces (small bowel faeces sign) confirming mechanical obstruction. The large bowel is collapsed. No other small bowel lesion is identified. Small amount of free fluid scattered throughout the abdomen and pelvis. No free gas.

Solid organs are normal. No lymphadenopathy. Lung bases are clear. No bony abnormality. No sacroiliitis.

Conclusion

Distal mechanical small bowel obstruction due to terminal ileitis and stricture, in a patient with known Crohn's disease.

Case Discussion

History of small bowel resection for Crohn's disease. Adhesions are the most common cause of mechanical SBO in adults. But in this case, the transition point is just proximal to the long terminal ileal stricture secondary to terminal ileitis in Crohn's disease.

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Case information

rID: 36542
Case created: 28th Apr 2015
Last edited: 31st Mar 2017
Inclusion in quiz mode: Included

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