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Intestinal obstruction due to adhesions

Case contributed by Fakhry Mahmoud Ebouda
Diagnosis certain

Presentation

An elderly female patient with previous hysterectomy and salpingo-oophorectomies operation. She presents with persistent constipation and vomiting for 3 days.

Patient Data

Age: 65 years.
Gender: Female

Multiple air-fluid levels are seen centrally within dilated small bowel loops.

Significant severe dilatation of the small bowel till the proximal ileum. Maximum diameter reaching up to 4.5cm. Apart from the abrupt point of transition noted at the mid ileal loop at the umbilical region level towards the right iliac fossa. Multiple gas bubbles noted proximal to the site of transition. No mass or abnormal thickening of bowel loop noted at the site of transition. Distal ileum and large bowel appear collapsed with no fecal matter noted within. Small outpouching (diverticulum) is seen protruding from the cecum. Mild to moderate amount of free fluid noted at subphrenic, subhepatic, bilateral paracolic gutter and in the pelvic region. Bilateral simple cortical renal cysts are noted.

 

Post-surgical photos for the adhesive loop received from the operating surgeon.

Case Discussion

The typical case of adhesive small bowel obstruction underwent an urgent operation with photos received from the performing surgeon.

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