Presentation
Abdominal pain and per oral intolerance, nausea and feculent vomiting since 5 days ago.
Patient Data
Small bowel obstruction with a transition zone about 5 cm from the ileocecal valve is seen. A 15 cm length loop of distal ileum just before the transition zone seems to be a closed loop and contains small bowel feces. Multiple adhesions are the probable underlying cause. Moderate ascites is noted but no sign of strangulation or perforation is present.
The blue arrow points to distal transition zone, with small bowel feces (red arrow) proximal to it, another site of bowel narrowing (yellow arrow) is seen more proximally leading to closed loop formation of a 15 cm length distal small bowel.
The CT findings were confirmed at surgery, the photo during surgery shows the proximal transition zone.
Case Discussion
The patient was severely dehydrated so initially underwent fluid resuscitation before surgery. Surgery performed about 20 hours after admission. At surgery, a 15 cm closed loop of small bowel entrapped by an adhesion band was found about 5 cm from the ileocecal valve without signs of strangulation.