Small bowel obstruction due to colorectal cancer recurrence
Previous surgery for rectal cancer, including ileostomy and colostomy. Also splenectomy. Now has 2 days of vomiting and abdominal distension. ?adhesional obstruction
CT abdomen and pelvis
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Right-sided ileostomy and left-sided colostomy, splenectomy.
Acute high-grade small bowel obstruction with a jejunal loop pinched by a soft tissue deposit in the left side of the abdomen. This soft tissue mass extends into the abdominal wall musculature and the anterior surface of the iliacus muscle. A further irregularly marginated soft tissue mass is present anteroinferior to the tail of the pancreas.
When someone with a history of surgery for colorectal cancer presents with symptoms and signs of bowel obstruction, the principal diagnoses to be considered are adhesions, hernia (either a co-incidental inguinal or femoral hernia, or related to the surgery such as an incisional hernia), and recurrence.