Small bowel obstruction

Case contributed by Ian Bickle

Presentation

Four days of absolute constipation and abdominal distension. Hysterectomy and bilateral salpingo-oophorectomy for malignancy. Recent change in bowel habits ?cause of obstruction

Patient Data

Age: 70 years
Gender: Female
x-ray

Multiple dilated loops of small bowel.

The large bowel is collapsed.

ct

Hysterectomy.

Multiple distended, predominantly fluid field loops of small bowel with fluid levels. The maximum transverse diameter of the small bowel is 4.7 cm. Transition point low in the left side of the pelvis with two points obstructed in one location along the course.

1.2cm enhancing serosal/mural based nodule on the second part of the duodenum.

A small amount of pelvic free fluid. No free gas.  Unremarkable appearances of the solid organs.

 

Annotated image

Obstruction of two points along the course of a bowel loop in close proximity indicating closed loop obstruction.

Case Discussion

High grade adhesional small bowel obstruction at two points along the course in one location consistent with a closed loop obstruction.

Adhesions following hysterectomy are one of the typical causes of a small bowel obstruction.

Also not the common problem of getting a distended abdomen covered on plain radiograph.  You have to put the pieces of the jigsaw together in your mind to get an overall impression.

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