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Small bowel obstruction

Case contributed by RMH Core Conditions

Presentation

Nausea/vomiting.

Patient Data

Age: 55
Gender: Female
X-ray

Dilated loops of proximal small bowl with associated air fluid levels. Fecal material and gas within the large bowel. Findings are in keeping with either an early or subacute small bowel obstruction.

CT

There are multiple dilated small intestinal loops in the central abdomen. Although there is collapse of the mid to distal ileum, a definite transition point is difficult to distinguish. 

Colonic loops are normal in caliber. No soft tissue mass or concentric mural thickening is identified.

Fluid is demonstrated in the hepatorenal recess, right paracolic gutter and between dilated small intestinal loops in the major pelvis.

No free gas is identified. No enlarged retroperitoneal or mesenteric lymph nodes. The liver, spleen, kidneys, adrenal glands, pancreas and gallbladder are normal in appearance. Fibroid uterus. NGT and IDC in situ.

Conclusion

Mechanical small bowel obstruction at the level of the mid ileum in the left iliac fossa, ? adhesive.

 

Case Discussion

Adhesive small bowel obstructions are the most common type. 

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