Case 2:  Closed Loop Obstruction

This patient has dilated loops of proximal small bowel with multiple air-fluid levels.  The distal loops of small bowel are decompressed.  This is a small bowel obstruction.  A loop of distended small bowel in the mid pelvis loops back onto itself.  The bowel proximal to the loop is distended.  The bowel distal to this loop is decompressed.  You cannot appreciate the loop in a single frame.  However follow the loop on the cine until you are convinced of this.  There is also ascites in the pelvis.

This patient has a small bowel obstruction with a closed loop in the deep pelvis.  This could be caused by adhesions, twisting of the bowel on its mesentery, or an internal hernia.  The presence of ascites suggests that the closed loop is becoming ischemic  The bowel is not thickened and there is no free air. At surgery, there were adhesions causing a closed loop obstruction. 

The bulky heterogeneous appearance of the uterus is typical for fibroids.

Take home points:

• Dilated small bowel with distally decompressed loops indicates an obstruction.  You will not always be able to find the transition point.  Look in the right lower quadrant and pelvis for distally decompressed loops.
• A closed loop obstruction, ascites, or bowel wall thickening are indications for considering surgery.