Small bowel obstruction related to adhesive disease, ascariasis
Presentation
Abdominal pain, nausea.
Patient Data
Hepatic steatosis. Oral contrast has been administered. There is dilation of the mid through distal small bowel with rapid, abrupt transition in the right lower quadrant, with an area of slight twisting and angulation, associated with a segment of relatively fecalized small bowel which does not contain oral contrast. There is also an incidental worm within the mid small bowel. Uterus is surgically absent. Incidental left adrenal nodule with benign features.
Case Discussion
Good illustrative example of small bowel obstruction due to adhesive disease, with relatively sharp angulation at the point of transition in the pelvis, near the site of prior hysterectomy, helping to support a the explanation for the obstruction. Note how the oral contrast has not yet reached the point of transition, and the contents appear relatively fecalized. Also noticed that upstream, there is a tubular filling defect within the small bowel that is typical for a parasitic worm, ascariasis, in this endemic region.
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