Closed loop small bowel obstruction

Multiple dilated small bowel loops in the right flank, converging centrally with a beaked appearance. Dual transition points seen both up and downstream of the dilated loops. Associated mesenteric edema and venous congestion. Short length mural thickening and hypoenhancement of the medial loop. Scattered free fluid in the abdomen, no free gas or portal venous gas. No gas within the portal vein. The proximal loops of small bowel are distended. The stomach is markedly distended. Multiple prominent mesenteric lymph nodes in the upper abdomen.

The multiple low density cystic lesions surrounding the pancreas represent known IPMNs. Status post cholecystectomy. Small left inferior pole simple renal cyst. Nodular appearance to the liver, which enhances homogenously. No focal hepatic lesions identified. Diverticular disease of the sigmoid colon with no evidence of diverticulitis.

Portal vein is clear. Diffuse, nonobstructive arterial calcification throughout the abdominopelvic arteries.

Multifocal bilateral pleural plaques reflecting previous asbestos exposure. Bibasilar atelectasis and bronchiectasis. The pleural based soft tissue mass in the posterior right lower lobe is longstanding and stable. Pacemaker leads in situ. Dense triple vessel coronary artery calcification.

Extensive degenerative disease of the lumbosacral spine with old L1 compression fracture.

Impression

Multiple dilated loops of small bowel in the right flank with abrupt transition points, venous congestion and surrounding stranding with thickened loop of bowel, concerning for closed loop obstruction, with early features of ischemia. Small volume free fluid. No features of perforation or portal venous gas at this stage.

Urgent surgical referral recommended.