Presentation
Abdominal distention for five days associated with diffuse abdominal pain, nausea, vomiting and constipation.
Patient Data
Dilated small bowel loops reach up to 34 mm at maximum diameter, with air fluid levels associated with minimal intra-peritoneal free fluid. The transitional point is noted in the lower left para-midline region. No obvious oral contrast passes to the colon. There were no signs of mesenteric ischaemia, wall thickening, bowel focal masses, or pneumoperitoneum.
The diagnosis was made as an acute small bowel obstruction, most likely adhesional.
Otherwise, normal.
Operative notes:
A midline incision was done, centring the umbilicus.
When the peritoneum was opened, a clear fluid came out.
The swab had no bowel content.
The small bowel was dilated.
The area of obstruction was noted in the lower left quadrant, where a small bowel was trapped and kinked inside one of the epiploic appendices of the sigmoid colon, and the bowels distal to it were collapsed.
Bowel vascularity was normal.
The adhesive band was cut on two clamps, and then the evacuation of the bowel content above was done.
All large bowel movements were felt and checked.
No other bands were found.
Case Discussion
Small bowel obstruction accounts for about 80% of all mechanical intestinal obstruction.
In this case, the patient gave a history of appendicectomy many years ago, and the diagnosis was made based on clinical history and radiological findings.
Adhesion refers to a band of fibrous tissue, almost exclusively from prior surgery.
I would like to express my gratitude to Dr. Fisal Elgowhary and Dr. Mohammed Gaafer Elamin, SQH Surgery Department, for their informative operative notes.
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