CASE 2123 Published on 28.03.2003
0

Multiple adhesions and small bowel closed loop obstruction

Section

Abdominal imaging

Case Type

Clinical Cases

Authors

Papi MG, Bizzarri G, Del Vescovo R, Leone PC, Cecconi L

Connected authors
Patient

67 years, female

Categories
No Area of Interest ; Imaging Technique CT, CT, CT, CT, CT
Download as PDF Print Show related cases Notify admin
Clinical History
Patient admitted to the emergency department with diffuse abdominal pain and tenderness, nausea and vomiting.
Imaging Findings
The patient was admitted to the emergency department with diffuse abdominal pain and tenderness, nausea and vomiting. She had a history of multiple abdominal operations. Clinical and conventional radiographic findings were confusing. Spiral CT scan was performed with findings of small bowel high degree obstruction by adhesions and fluid-gas levels. Moreover a small bowel volvulus was visible, like a fixed loop,”U” shaped, fluid filled, with thickened wall and thickened mesenteric root. An emergency laparotomy was performed which confirmed the imaging findings, the postoperative course was good.
Discussion
Patients with closed loop obstruction and volvulus have a higher risk of morbidity and mortality, than patients with simple obstruction, because they evolve to bowel ischemia if the diagnosis is delayed. In this case small bowel volvulus occurred as a complication of a high degree of intestinal obstruction caused by adhesive bands which aggravated the mechanical obstructive process. CT allowed an accurate diagnosis and thus treatment in a short time interval.
Differential Diagnosis List
Small bowel obstruction complicated by volvulus
Final Diagnosis
Small bowel obstruction complicated by volvulus
Case information
URL: https://www.eurorad.org/case/2123
DOI: 10.1594/EURORAD/CASE.2123
ISSN: 1563-4086
Figure 1

Figura 1

Figura 1
Volvulus of the small bowel: "U" shaped loop.
Figura 1
Volvulus of the small bowel: thickening of the small bowel wall.
Figura 1
volvulus of small bowel
Figura 1
volvulus of small bowel, "U" shaped loop
Figure 2

Figura 2

Figura 2
Small bowel fluid-gas levels ;higher fluid rate than gas; diameter of loops => 3cm.
Figura 2
Small bowel fluid-gas levels; higher fluid rate than gas
Figura 2
Distended small bowel loops: diameter = > 3 cm
Figura 2
Fluid filled small bowell loops, diameter = > 3cm
Figure 3

Figura 3

Figura 3
"TZ" transition zone between the distended proximal part and collapsed distal part of the bowel.
Figura 3
"TZ" transition zone between the distended proximal part and collapsed distal part of the bowel.
Figura 3
"TZ" transition zone between the distended proximal part and collapsed distal part of the bowel
Figura 3
"TZ" transition zone between the distended proximal part and collapsed distal part of the bowel
Figure 4

Figura 4

Figura 4
The ileal distal tract is collapsed: the obstruction level is proximal.
Figura 4
The sigmoid colon is collapsed.
Figura 4
Sigma is collapsed
Figura 4
Sigma is collapsed
Figure 5

Figura 5

Figura 5
Thickening of the mesenteric root
Figura 5
Mesenteric root is thickened