PMC6174802_01
Contrast enhanced CT of the abdomen and pelvis demonstrating closed loop obstruction in the right lower quadrant. (a) Axial CECT demonstrating a proximal transition point within the proximal ileum (dashed arrow) and a nearby distal transition point within the distal ileum (solid arrow). The dilated bowel loops (*) are anterolateral to the cecum (open arrowhead) and anterior to the ascending colon (closed arrowhead). (b) Coronal CECT image demonstrating multiple dilated small bowel loops confined to the right abdomen. Note the diminished enhancement of the dilated small bowel loops.
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A contrast enhanced CT abdomen and pelvis was obtained, demonstrating multiple fluid-filled, dilated small bowel loops in the right abdomen, which were predominantly anterolateral to the ascending colon and cecum (Figure 1).
Axial CECT image demonstrating mucosal hyperenhancement of the ileum at the proximal transition point related to ischemia or decompressed state (dashed arrow). Kinking of the ascending colon (closed arrowhead) and transverse colon (open arrowhead) was retrospectively felt to represent the site of the epiploic appendage adhesion.
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Mucosal hyperenhancement of the ileum at the proximal transition point was felt to relate to ischemia or decompressed state (Figure 2). Retrospectively, kinking of the ascending and transverse colon could be seen on the initial abdominal CT and was felt to correspond with the site of adhesion (Figure 2).
Intraoperative images. (a) and (b) Closed loop obstruction was detected intraoperatively with nonviable bowel (*) which was subsequently resected.
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The herniated small bowel was nonviable and a total of 60 cm of small bowel was resected (Figure 3).