Presentation
Nausea, vomiting, abdominal pain.
Patient Data
High grade small bowel obstruction with transition point in the distal ileum. Fecalized contents lead to the transition point. Mild thickening of the distal decompressed ileum to the IC valve, with slightly clustered appearance. Small ascites.
Case Discussion
This case is appropriately interpreted as a distal small bowel obstruction, with a clear transition point in the right lower quadrant with fecalized contents leading into the transition. The patient failed conservative management with NG tube, and eventually was taken to surgery where they found his distal ileum had fallen into a distal surgical internal hernia defect created by his recent hernia surgery. This is a very difficult call to be made prospectively, but perhaps it could have been considered based on the relatively clustered/confined appearance of the ileum beyond the transition point (specifically notable on the sagittal reformats, where there is downward angulation of the small bowel at the transition point at it falls into the defect; this is very challenging to notice on axial images alone).
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