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Distal ileal obstruction

Case contributed by Liz Silverstone
Diagnosis certain

Presentation

Intractable bilious vomiting. Distal small bowel obstruction diagnosed by CT (not available).

Patient Data

Age: 65 years
Gender: Female

2 hours post Gastrografin

x-ray

Multiple loops of distended small bowel. Proximal small bowel contains Gastrografin. Colon empty.

24 hours

x-ray

Multiple loops of distended small bowel containing Gastrografin. Colon empty.

48 hour

x-ray

Multiple loops of distended small bowel containing Gastrografin. Colon empty.

Case Discussion

There is slow progression of Gastrografin through the obstructed ileum, with an empty colon at 48 hours indicating high-grade obstruction. Usually, failure of contrast to reach the large bowel by 24 hours indicates a failed water-soluble contrast challenge. Closed-loop obstruction seen on CT (not available).

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