PMC4446662_01
Admission abdominal film: distended small bowel loops seen in the upper abdomen.
gr1.jpg
PMC4446662_01_gr1.jpg
fig0005
Plain abdominal film revealed dilated loops of small bowel, and a presumed diagnosis of adhesive small bowel obstruction was made Fig. 1.
Abdominal film-contrast study: distended small bowel loops and failure of contrast to reach the pouch.
gr2.jpg
PMC4446662_01_gr2.jpg
fig0010
With failure to improve within 72 hours of conservative management (including oral Gastrograffin) and a further abdominal film displaying dilated small bowel (6 cm in diameter) and no passage of contrast into the ileoanal pouch Fig. 2, the decision was made for surgical intervention.
Intraoperative findings: small bowel passing through the foramen of Winslow.
gr3.jpg
PMC4446662_01_gr3.jpg
fig0015
At laparotomy, a closed loop small bowel obstruction through an internal hernia was noted Fig. 3.
Intraoperative findings: incarcerated small bowel in the surgeons hand. Note the tight "band" of gastric tissue.
gr4.jpg
PMC4446662_01_gr4.jpg
fig0020
The herniated trapped small bowel was discolored by ischemia Fig. 4.
Intraoperative findings: defect highlighted whilst small bowel hernia is reduced. Obstructing "band" now more clearly defined as stomach.
gr5.jpg
PMC4446662_01_gr5.jpg
fig0025
The hernia was subsequently reduced ad the bowel rapidly "pinked" up with no requirement to resect any small bowel; the defect in the lesser curve was closed with 4-0 PDS Fig. 5.