CT of Acute Abdomen

Epigastric Pain series 7 RESIDENT COURSE Answer [ER Case 33]

Simple small bowel obstruction.









Collapsed ascending colon (Ac) and cecum (Ce) in Fig.4-Fig.6 are suggestive of mechanical small bowel obstruction. Mild mesenteric stranding (black arrowheads) is shown in Fig.1-Fig.4, but, no ascites and well contrast-enhanced wall of distended small bowel mean high possibility of simple obstruction. Black arrows of Fig.12-Fig.14 manifest "small bowel feces" which is suggestive of a site of the obstruction of simple obstruction in many cases. Black arrow of Fig.12 represents caudal transition zone and connects to non-distended terminal ileum (Ti) of Fig.11. Cephalad side progresses in number order starting from 1 of Fig.12 as shown. ab of Fig.8 are divided into a and b, and ascend to Fig.1, and cd of Fig.7 do likewise. Because no other sites of obstruction in neighborhood of black arrow of Fig.12 are recognized, diagnosis of simple obstruction at terminal ileum can be made. CE: cecum. Conservative treatment by ileus tube was successful.











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