CT of Acute Abdomen

Epigastric Pain series 7 EXPERT COURSE Answer [EE Case 33]

Strangulated obstruction with necrosis












Fig.34-Fib.37 are abbreviated. No fluid content in right colon, ascites (reference mark) Fig.1-Fig.4 and Fig.37-Fig.38, gasless distended small bowel and mesenteric stranding (black arrowhead of Fig.13-Fig.16), these 4 findings are strongly suggestive of strangulated obstruction. On tracking down from A and 1 of Fig.33, A obstructs at D of Fig.19, and 1 at 16 of Fig.17 confirming closed loop formation, and Fig.18 presents beak sign (black arrow). There are collapsed small bowels (SB of Fig.17 and Fig.18), and small bowel distended with gas of circle number 5 of Fig.22 from circle number 1 of Fig.18 probably represents simple obstruction. Degree of wall enhancement is equivocal and suggests high possibility of necrosis. Above findings were confirmed at surgery, and nonviable 80cm ileum was strangulated by an adhesive band.

























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