This is a case of closed-loop obstruction as the transition points are in close proximity to each other (double beak sign) which is complicated by ischemia, evident from the change in bowel wall enhancement within the closed loop, mesenteric congestion and fluid. There is also the additional finding of a blind-ending loop, which was confirmed to be a Meckel's diverticulum on histology. The patient was taken to theater and underwent resection of the ischemic portion of the bowel. An internal hernia was thought to be the cause of the obstruction.

Histology:

The resected small bowel demonstrates acute hemorrhagic ischemic necrosis. A diverticulum is noted which is thin walled and ischemic, which would be in keeping with a Meckel's diverticulum. No gastric or pancreatic mucosa is noted.