Small bowel obstruction

Case contributed by Dr Tom O'Graphy

Presentation

Abdominal pain and distension. Dark vomiting. No shock. No fever.

Patient Data

Age: 90
Gender: Female

Abdominal radiograph

Modality: X-ray

Abdominal radiograph showing dilated bowel in the lower abdomen.

Bedside ultrasound

Modality: Ultrasound

It seems there's no fluid around the liver or in the Morison's pouch.

CT-scan

Modality: CT

Marked dilatation of the stomach and small bowel loops. Bowel wall thickening in left lower quadrant, at the transition area of dilated and collapsed small bowel.

Mesenteric hyperemia and fluid infiltration of surrounding fat.

Small foci of gas around the bladder, and also under peritoneum inside the bladder. This is not typical for gastrointestinal perforation.

No abnormalities in the pancreas, spleen, kidneys, adrenal glands or liver. No peritoneal effusion. Colon is normal. There is an uncomplicated diverticulosis of the sigmoid colon.

Case Discussion

The findings are compatible with fibrous abdominal adhesion from a older surgical intervention.

This woman was operated upon 10 years ago for another small bowel obstruction. She didn't remember if the last time she had similar pain she had similar dark-brown (possibly fecaloid) vomiting.

This patient was been hospitalized and placed under aspiration precautions while waiting for surgical intervention.

CT scan was ordered by the surgeon for preoperative evaluation (she has normal renal function so IV contrast was used). As with many older people, the patient didn't complain very much about the pain even though her abdomen was tense.

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Case Information

rID: 36878
Case created: 14th May 2015
Last edited: 28th May 2016
Inclusion in quiz mode: Included

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