Closed loop small bowel obstruction

Case contributed by Dr Michael P Hartung

Presentation

Severe abdominal pain.

Patient Data

Age: 55
Gender: Female

Isolated segment of dilated small bowel with mesenteric edema. Two adjacent transition points in the left lower abdomen indicating the obstruction at two points (a closed loop), best seen on the coronal images. Short segment of dilated small bowel which appears to be leading into the closed loop segments, with otherwise normal caliber upstream bowel. Moderate gastric distention. 

No pneumatosis or free air. 

CT

Annotated image

Circle indicates the site of obstruction of the small bowel as it ENTERS and EXITS the closed loop. Notice they are right next to each other, as is most often the case. 

Case Discussion

Unfortunate case of a closed loop obstruction inappropriately diagnosed as an uncomplicated small bowel obstruction. 

Patient was managed conservatively with nasogastric decompression for 2 days, until her lactate rose from 2 to 10. In the OR, 80 cm of infarcted small bowel was resected. 

This case serves as a sobering reminder of the importance of timely diagnosis of closed loop obstruction! 

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Case information

rID: 65403
Published: 8th Jan 2019
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included

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