Presentation
Abdominal pain, nausea, vomiting.
Patient Data
Dilation of the stomach and small bowel with the gradation of oral contrast density into fluid density in the pelvis. Fecalized distal small bowel leading into a transition point with abrupt narrowing, with decompressed and somewhat clustered distal small bowel in the pelvis and small adjacent ascites. The distal small bowel remains decompressed and tracing it distally to the cecum there is gentle angulation and narrowing of the terminal ileum at the presumed site exiting the internal hernia (note how this is adjacent to the first transition point). Also labeled on coronal images - IN and OUT.
Case Discussion
This appears to be a relatively straightforward small bowel obstruction with single transition point in the pelvis, where the distal fecalized small bowel leads into an abrupt transition point (presumably adhesive at first glance). However, this patient proceeded to surgery due to worsening pain and was found to have an internal hernia through a peritoneal window in the pelvis associated with prior herniorraphy. In retrospect the decompressed distal small bowel can be followed to the presumed site of exit of the internal hernia a few cm before the IC valve.
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