Age: 69
Sex: Female
Indication: Generalized abdominal pain
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Case #2
Findings
- Chest
- 10 mm right middle lobe pulmonary nodule
- Abdomen/Pelvis
- Multiple dilated loops of small bowel in a fixed radial distribution with swirling of the feeding mesentery. These affected loops show mucosal edema and hypoenhancement without pneumatosis or portal venous gas
- Segmental mural thickening of the transverse colon
- Extensive descending and sigmoid colonic diverticulosis
- Cholelithiasis
- Fat-containing infraumbilical ventral abdominal wall hernia with mild internal fat stranding
- Distended urinary bladder
- MSK
- No acute findings
- Polyarticular degenerative changes
- Osteopenia
Diagnosis
- Closed-loop bowel obstruction
Sample Report
Isolated dilated segment of small bowel with swirling of the feeding mesentery and mucosal hypoenhancement concerning for closed-loop obstruction with possible ischemic changes. No pneumatosis or portal venous gas. Recommend surgical evaluation.
Segmental mural thickening of the transverse colon which is nonspecific and may relate to infectious, inflammatory, or ischemic etiologies.
Small fat-containing infraumbilical ventral abdominal wall hernia with mild internal fat stranding. Recommend correlation with clinical signs of incarceration.
10 mm right middle lobe nodule. Recommend correlation with prior imaging if available to document stability. Otherwise, consider PET/CT for further evaluation.
Extensive distal colonic diverticulosis.
Cholelithiasis.
Discussion
- Closed-loop bowel obstructions can be sneaky. Look for an edematous bowel loop with an abrupt transition to normal at either end and swirling of the feeding mesenteric vessels
- Closed-loop obstructions most often are associated with hernias or volvulus, but because there are so many possible types of internal hernias, many of which can be very difficult to classify, it is more important to be able to recognize signs of a closed-loop obstruction than to identify hernias
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