Small bowel feces sign

Case contributed by James Sheldon
Diagnosis almost certain


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

Patient Data

Age: 60 years
Gender: Female

The distal ileum is dilated to 32 mm and contains feces-like material. There is a transition point to normal caliber 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 subcentimeter hypodense lesion in the lower pole of the left kidney is too small to definitively characterize on CT.

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

The lung bases are clear.

No destructive osseous lesion.


Findings are consistent with a small bowel obstruction with "small bowel feces 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 feces sign" is defined by the presence of particulate feculent 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 feces sign is most often present in distal small intestine loops.

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