結腸の拡張を認めず小腸閉塞である．図１と図１７で少量の腹水があり（※），拡張した小腸はgaslessで，図８で軽度だが腸間膜の濃度上昇を認め（▲），絞扼性小腸閉塞を疑うべきである．図１６の1とAから追跡すると図７の32とJとなり同部位で閉塞し，closed loopである．図６と図７で虚脱した小腸（SB）があり，図６の丸数字１は図７の32とは内容物が違うので連続せず，単純閉塞の起始部であり，丸数字のように進展すると解釈する．Closed loopを形成している小腸壁の造影効果は単純閉塞のそれと同等であり，壁肥厚も認めず壊死はない．腹痛が増強したので手術となった．小腸中央部で癒着と索状物により約50cmの小腸がclosed loopを形成し絞扼されていたが，壊死所見はなく索状物切離と癒着剥離を施行した．

文献考察：小腸閉塞の術後死亡率と合併症が高いファクターは，高齢者（特に75歳以上），重篤な基礎疾患，腸管壊死を伴った絞扼性小腸閉塞，24時間以上治療が遅れた例であった．
Ann Surg. 2000 Apr;231(4):529-37.
Complications and death after surgical treatment of small bowel obstruction: A 35-year institutional experience.
Fevang BT, Fevang J, Stangeland L, Soreide O, Svanes K, Viste A.

OBJECTIVE: To study factors influencing complications and death after operations for small bowel obstruction (SBO) using multifactorial statistical methods. SUMMARY BACKGROUND DATA: Death after surgery for SBO is believed to be influenced by factors such as old age, comorbidities, bowel gangrene, and delay in treatment. No studies have been reported in which adverse factors related to death and complications have been systematically investigated with modern statistical methods. METHODS: The authors studied retrospectively 877 patients who underwent 1,007 operations for SBO from 1961 to 1995. Patients with paralytic ileus, intussusception, and abdominal cancer were excluded. Odds ratios for death, complications, postoperative hospital stay, and strangulation were calculated by means of logistic regression analyses. RESULTS: Death and complication rates decreased during the study period. Old age, comorbidity, nonviable strangulation, and a treatment delay of more than 24 hours were significantly associated with an increased death rate. The rate of nonviable strangulation increased markedly with patient age. Major factors increasing the complication rate were old age, comorbidity, a treatment delay of more than 24 hours, and the need for repeat surgery. CONCLUSION: Death and complication rates after SBO decreased from 1961 to 1995. Major factors influencing the rates were age, comorbidity, nonviable strangulation, and treatment delay. Nonviable strangulation was more common in old patients.PMID: 10749614
追記：手術死亡率は，単純閉塞例で4%，絞扼性小腸閉塞でviable腸管（腸管切除なし）例で3%，non-viable（腸管壊死）例で16%でviable例の5倍以上．術後合併症は，単純閉塞例で22%，絞扼性小腸閉塞でviable腸管例で16%，non-viable例で36％でviable例の2倍以上であった．