Demographics:
84 years old, Male
Indication:
Worsening abdominal pain after cholecystectomy
Findings
Lower chest
- Right greater than left dependent bilateral lower lobe groundglass opacities
Abdomen/Pelvis
- Herniation of a loop of small bowel through a midline incisional hernia with associated upstream small bowel and gastric distension. Small bowel loops measure up to 3.5 cm in diameter
- No pneumatosis or portal venous gas
- Small volume free fluid and pneumoperitoneum without loculated collection
- Subcentimeter hepatic hypoattenuating lesions which are too small to characterize
- Cholecystectomy
- Nonobstructing interpolar right renal calculi measuring up to 3 mm
- Left upper pole renal cortical scarring
- Subcentimeter hypoattenuating lesions in the left kidney, which are too small to characterize
- Gastric suction tube loops on itself in the lower thoracic esophagus
- Prostatectomy
- Atherosclerotic calcification of the abdominal aorta and branch vessels without aneurysm
MSK
- No acute findings
- Polyarticular degenerative changes
Diagnosis
Small bowel obstruction due to incisional hernia
Sample Report
Herniation of a loop of small bowel through a small midline incisional hernia with associated small bowel obstruction. Recommend correlation with clinical signs of incarceration.
No pneumatosis or portal venous gas to suggest ischemia.
Expected postoperative small volume ascites and pneumoperitoneum without drainable collection.
Gastric suction tube is looped on itself in the lower esophagus. Recommend repositioning.
Nonobstructive right nephrolithiasis.
Discussion