Small bowel obstruction due to large suprapubic incisional hernia

Surgical clips projected over the lumbosacral region. Dilated small bowel loops in the lower abdomen and pelvis. Gas-filled bowel loops projected over the right hip joint suggesting a lower abdominal incisional hernia. Fecal material in the ascending colon. No free gas or pneumotosis.

The NGT is looped within the large hiatus hernia. IDC in situ.

Multiple dilated loops of small bowel throughout the abdomen with a transition point in the large suprapubic hernia, in keeping with a mechanical small bowel obstruction. The hernial neck measures 55 mm and contains mesenteric vessels, small bowel and fat. No pneumatosis. There are several locules of air which appear to be separate to bowel the inferior hernial sac ? contained perforation. Subcutaneous air is also noted adjacent to some surgical material/clips at the superior aspect of the hernial sac. No pneumoperitoneum or portal venous gas. The terminal ileum is collapsed and the large bowel appears within normal limits with moderate fecal loading. No intra-abdominal collection.

Cholelithiasis without CT evidence of acute cholecystitis. The liver, spleen, pancreas and adrenal glands appear normal. Small renal cortical cysts.

Calcified plaque within the abdominal aorta without aneurysmal dilatation. The IVC and portal vein opacify normally. No abdominal lymphadenopathy.

Visualized lung bases demonstrate atelectatic changes. Minor bronchiectasis in the left lower lobe. Mitral annular calcification.

Multilevel degenerative changes of the imaged the spine. Surgical clips in the lower lumbar prevertebral region. Atrophy of the right iliopsoas muscle.

IMPRESSION

1. Mechanical small bowel obstruction with a transition point in the large suprapubic hernia. Small locules of air within the inferior hernial sac appear separate from bowel and may represent a contained perforation. Subcutaneous air is present at the superior aspect of the hernial sac, ? recent instrumentation.
2. The nasogastric tube is looped within the large hiatus hernia with intrathoracic stomach and requires repositioning.