Small bowel obstruction

Case contributed by Jeremy Jones
Diagnosis almost certain


Severe abdominal pain. Vomiting.


Grossly distended small bowel loops with the impression of wall-thickening. The hepatic flexure is demonstrated in the right upper quadrant.

Annotated image

Annotated abdominal radiograph of small bowel obstruction showing multiple gas-filled dilated loops of small bowel. We know that this is dilated small bowel because of it's location (central) and the fact that it has valvulae conniventes.

Case Discussion

This abdominal film demonstrates why the abdomen is distended. There are multiple loops of gas-filled small bowel which are in a predominantly central distribution.

Features here are of small bowel obstruction for which there are many potential causes. Check that there isn't gas in a loop of bowel incarcerated in the femoral canal!

The next thing to do is look for complications of small bowel obstruction, such as pneumoperitoneum secondary to perforation, intramural gas (gas within the bowel wall) or portal venous gas secondary to ischemia.

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