Demographics:
58 years old, Female
Indication:
Vomiting, concern for bowel obstruction
Findings
Lower chest
- Mild mural thickening of the distal thoracic esophagus
- Mild dependent atelectasis
Abdomen/Pelvis
- Multiple dilated loops of small bowel throughout the abdomen measuring up to 3.5 cm in diameter with a transition to normal caliber in the distal ileum
- The jejunum and ileum are on opposite sides of the abdomen (jejunum on the right and ileum on the left) with a sac-like configuration of the displaced ileal loops and associated edema in the ileal mesentery
- 2 cm periampullary duodenal diverticulum
- Scattered subcentimeter hypoattenuating structures in the liver, which are too small to characterize
- Focal fatty infiltration adjacent to the falciform ligament
- Gallbladder is mildly distended but otherwise unremarkable, likely related to the patient's fasting state
- Small calcified granuloma in the spleen
- Subcentimeter bilateral renal hypoattenuating lesions, which are too small to characterize
- Nonobstructing calculi versus papillary tip calcifications in the lower pole of the left kidney measuring 3 mm or less
- Small volume abdominopelvic ascites
- Hysterectomy
MSK
- No acute findings
- Posterior spinal fusion hardware spanning L4-S1
Diagnosis
Closed-loop small bowel obstruction
Sample Report
Small bowel obstruction with transition point in the distal ileum. The configuration of displaced loops of jejunum and ileum raises concern for closed loop obstruction related to an internal hernia. No evidence of bowel ischemia.
Small volume ascites, likely reactive.
Mild mural thickening of the distal esophagus, which can be seen with esophagitis.
Discussion