Small bowel obstruction - adhesional

Case contributed by Dr Ian Bickle

Presentation

Distended abdomen. Nausea and vomiting. Bowel obstruction?

Patient Data

Age: 70 years
Gender: Female

Multiple dilated loops of gas filled small bowel.

Large bowel collapsed.

Right iliac stent.

The small bowel is moderately distended and fluid filled.

Small bowel feces sign in the distal ileum, prior to an abrupt caliber change (transition point) 2-3cm from the ileocecal valve.

The large bowel is collapsed.

No free gas.

Suprapubic catheter.  

Fatty liver. 

Case Discussion

This case is a nice example of a high grade adhesional distal small bowel obstruction. 

The 'hold up' is evident with the small bowel feces sign and the abrupt transition point without any structural cause is classic of an adhesional small bowel obstruction.

This was confirmed at laparotomy.

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