Small bowel obstruction

Within the left iliac fossa are a tangle of closely applied dilated small bowel loops containing air-fluid levels, with surrounding inflammatory stranding but no associated fluid collection or extra luminal gas to suggest perforation.  The bowel loops entering and leaving the dilated segment are closely adjacent but without focal luminal narrowing or beaking.  No bowel wall thickening or intramural gas. Jejunal loops proximal to the tangle of bowel loops contain oral contrast which does not reach the dilated segments in the iliac fossa.  Small bowel distally remains collapsed.

There is a trace of pelvic free fluid. No retroperitoneal or mesenteric enlarged lymph nodes. Prominence of the common bile duct to a maximal diameter of 7 mm. No intrahepatic bile duct dilation. Calcified gallstone noted. The pancreatic duct is dilated up to 4 mm. It can be traced to the to the duodenal ampulla, which is prominent, and projects 6mm into the contrast within the duodenal lumen. Multiple well circumscribed hypodense lesions in the liver are consistent with cysts. The largest in segment 8 measures 10 x 14mm. The kidneys are normal apart from an 18mm cyst exophytic from the right lower pole. Normal adrenal glands. NGT in situ.

Conclusion

Partial or early small bowel obstruction predominantly involving closely applied loops in the left iliac fossa is most likely adhesive. There is surrounding inflammatory stranding without evidence of perforation. Appearances suggest a closed loop obstruction.

The film taken 3.25 hours after oral contrast shows persisting dilated loops of jejunum in the left side of the abdomen with very little contrast passing into distal nondilated loops indicating high grade mechanical obstruction.