Presentation
History of appendectomy many years ago.
Patient Data
A cluster of thick-walled hypoenhancing loops of small bowel seen in the right abdomen with mesenteric congestion and edema and minor ascites.
This cluster has two nearby abrupt transition points with focal kinking of the bowel (afferent, efferent). The upstream bowel is dilated and fluid-filled and the downstream bowel is collapsed.
These features indicate closed-loop obstruction, and require urgent surgical referral.
Mild amount of abdominopelvic ascites.
Case Discussion
This patient was urgently transferred for surgery, which proved closed-loop obstruction due to adhesion. The involved loops were found to be ischemic and were resected with end-to-end anastomosis.
Closed loop obstructions occurs when two points along the course of the bowel are obstructed, usually but not always the transition points are adjacent at a single location
Closed loop small bowel obstructions are usually secondary to adhesions, volvulus, or hernia (external or internal). Those with a Roux-en-Y gastric bypass are at increased risk for closed loop obstruction, a result of surgically created rents in the mesentery
Closed loop obstructions are at higher risk than non-closed loop obstructions for strangulation (compromised blood supply) or distension-related ischemia, resulting in intestinal necrosis and perforation.
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