Small bowel obstruction due to an internal hernia

Case contributed by Ian Bickle
Diagnosis certain

Presentation

Right iliac fossa pain. Nausea, vomiting, tachycardia.

Patient Data

Age: 70 years
Gender: Male

The stomach and the majority of the small bowel is dilated and fluid filled down the right iliac fossa at the site of a closed loop obstruction.  The distal ileum is collapsed.

Partial reduction in the enhancement of the loop of small bowel in the closed-loop.  Small amount of perienteric inflammatory change and free fluid.

No free gas or collection.

Small amount of free fluid in the pelvis. 

Simple cyst in the right kidney. Normal appearance of the liver, spleen, pancreas, both adrenals.

Right middle and lower lobe consolidation with small associated pleural effusions. 

Case Discussion

The patient proceeded to surgery.  A closed loop obstruction due to an internal hernia was identified.  The small bowel in the closed loop was ischemic.

Resection and anastomosis was successfully undertaken.

 

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