The cluster of abnormal small bowel loops in the right nephrectomy bed is impressive. On a single coronal image, you might even think it looks like XGP on first glance!
Both afferent (going in) and efferent (going out) limbs of the closed loop are narrowed and obstructed at the same location, and can be difficult to distinguish from each other (best followed on the axial and sagittal images). Given the history of nephrectomy and the tight, focal narrowing resulting in closed loop obstruction, internal hernia cannot be favored over adhesion as the cause, although it would be appropriate to provide both in the differential diagnosis. Either way, this case is a surgical emergency as the vascular supply of the bowel has been compromised and concerning for ischemia (see operative note).
Companion cases of closed-loop obstructions:
- Internal hernia
- Adhesions 1
- Adhesions 2