Small bowel faeces sign

Case contributed by Dr James Sheldon

Presentation

Possibility of bowel obstruction, previous hysterectomy, known intraabdominal adhesions, come with complaints of nausea and vomiting.

Patient Data

Age: 60 years
Gender: Female
Modality: CT

The distal ileum is dilated to 32 mm and contains faeces-like material. There is a transition point to normal calibre terminal ileum in the pelvis. A swirling of mesenteric blood vessels is appreciated at this point. Fat stranding and a small volume of free fluid surround the distal ileum. Fecal loading within the large bowel.

The gallbladder, spleen, pancreas, right kidney and adrenals are unremarkable. Several cysts are identified within the liver, the largest is present in the right lobe and measures 36 mm x 34 mm in maximal axial dimensions. A subcentimetre hypodense lesion in the lower pole of the left kidney is too small to definitively characterise on CT.

No intra-abdominal free gas detected. Lymph nodes are not enlarged.

The lung bases are clear.

No destructive osseous lesion.

Conclusion

Findings are consistent with a small bowel obstruction with "small bowel faeces sign" present. Transition point in the distal ileum where there is a swirling of mesentery suggesting volvulus. No free gas to suggest perforation.

Case Discussion

"Small bowel faeces sign" is defined by the presence of particulate faeculent material mingled with gas bubbles in the lumen of the small intestine. It is the result of delayed intestinal transit and is believed to be caused by incompletely digested food, bacterial overgrowth, or increased water absorption of the distal small-bowel contents due to obstruction 1.

The small bowel faeces sign is most often present in distal small intestine loops.

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Case Information

rID: 32765
Case created: 13th Dec 2014
Last edited: 13th Oct 2016
Inclusion in quiz mode: Included

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