Axial and coronal CT with contrast, portal phase.
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The small bowel loops are seen lateral to the right colon and also anterior to the stomach. The appearances are likely to be due to an internal hernia probably through a defect in either the
mesentery or transverse mesocolon.
Arterial supply to the small bowel appears normal.
Note the stranding within the mesentery adjacent to the malpositioned caecum, and the free fluid adjacent to this, which is suggestive of incarceration of the internal hernia.
The superior mesenteric vein is not enhancing.
This is caused by delayed venous return from the gut (venous congestion), again suggesting that the internal hernia is incarcerated and there is likely early strangulation.
The correct position typically for jejuno-ileal anastomoses is the left upper quadrant and the fact that the anastomosis is in the right iliac fossa is concerning.
There is no small bowel dilatation. The stomach is not distended. The caecum is distended measuring 7.2 cm in maximum axial dimensions.
Note the stranding within the mesentery adjacent to the malpositioned caecum and the free fluid adjacent to this. In conjunction with the lack of enhancement of the portal vein, these findings are suggestive of incarceration of the internal hernia.