CT of Acute Abdomen

Epigastric Pain series 5 RESIDENT COURSE Answer [ER Case 24]

Strangulated obstruction with no necrosis.








Absence of colic liquid content indicates small bowel obstruction. Ascites (reference mark) in Fig.1 and Fig.17, distended and gasless small bowel, and stranding(black arrowhead) of mesentery in Fig.8, these 3 findings strongly suggest strangulated obstruction. 1 of Fig.16 can be traced back to 32 of Fig.7, and A to J of same Fig. leading to diagnosis of closed loop formation (strangulated obstruction). Fig.6 and Fig.7 show collapsed small bowel (SB). Because of different content, circle number 1 of Fig.6 does not connect to 32 of Fig.7 where simple obstruction begins. Wall of closed loop shows contrast-enhancement as good as wall of simple obstruction bowel indicating viability. Pain increased and patient was taken to surgery. 50cm small bowel was strangulated forming closed loop by an adhesive band, but found to be viable. Severance of a band and adhesionolysis were performed.










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