Small bowel obstruction and ankylosing spondylitis

Case contributed by Dr Andrew Dixon

Presentation

Abdominal pain and vomiting.

Patient Data

Age: 60 years
Gender: Male

Erect and supine abdominal radiographs reveal distended small bowel loops with multiple air fluid levels suspicious for a small bowel obstruction. There are classic features of advanced ankylosing spondylitis with fused sacroiliac joints, ossification of the supraspinous ligaments creating a dagger spine appearance, and vertebral syndesmophytes creating a bamboo spine appearance. Pelvic surgical clips noted. 

Small bowel obstruction with transition point anteriorly just to the right of midline at the level of the umbilicus where small bowel feces sign is seen. The location and appearance suggests an adhesion as the cause. Ankylosing spondylitis.  Pelvic surgical clips from previous prostatectomy.  

Case Discussion

Small bowel obstruction due to an adhesion from prior pelvic surgery. Nice example of the small bowel feces sign. Background ankylosing spondylitis

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