Presentation
Severe abdominal pain, absence of bowel motion and vomiting for 3 days. Had history of perforated gastric ulcer repair one year ago.
Patient Data
Small bowel loops dilatation at the central abdomen and left lumbar region. No pneumoperitoneum. Large bowel loops are not dilated.
"Whirlpool sign" indicates the twisting of small bowel mesentery noted at the level of L5/S1 level in umbilical region. Two transition points at the small bowel loops (ileum) near to the twisting of small bowel mesentery. Generalized dilatation of small bowel loops (including duodenum and stomach) with part of distal ileum is collapsed.
The dilated small bowel loops maintained their bowel wall and mucosa enhancement.
No pneumoperitoneum or intramural gas.
The large bowel loops are collapsed.
Minimal free fluid at perihepatic, mesentery, bilateral paracolic gutters and pelvis.
Focal lung consolidation at posterobasal segment of left lower lobe with tree in bud appearance of centrilobular lung nodules adjacent this consolidation.
Case Discussion
CT features are in keeping with small bowel obstruction due to two transition points secondary to adhesion bands.
Intraoperatively: there are 2 sites of adhesive obstruction:
1. 110cm proximal to terminal ileum to the retroperitoneum - causing complete obstruction
2. 320cm from DJ to the anterior abdominal wall - causing partial obstruction
Stomach until distal ileum are grossly dilated and edematous.
Devitalised segment of small bowel, 300cm from distal DJ - segmental resection (15cm in length) and double barrel ileostomy done at RIF
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