Small bowel obstruction - Case 1

  1. Red circle: the most striking thing is the small bowel loops that are clumped together. This makes you think of closed loop obstruction.
  2. Yellow arrow: there is bowel wall thickening.
  3. Red arrow: edema of the mesentery. This is probably the result of venous congestion.
  4. Blue and orange circles. Notice that the small bowel is lateral to the colon. This is very unusual.
    It is a sign of herniation of the small bowel through a hole in the mesocolon.
  5. Yellow arrow: as we go more caudally we reach the point of obstruction. The proximal small bowel has a sudden change in caliber. This is were the small bowel enters the hernia.
  6. Yellow arrow: at this same level we see where the herniated small bowel leaves the hernia. This is the last segment of the teminal ileum just before it reaches the cecum.
  7. We can draw a circle which indicates the hole in the mesocolon through which the ileum has herniated.

At surgery the herniated bowel was slightly blue, but after repositioning the bowel through the hole in th emesocolon, the normal color reappeared within 15 minutes.

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