This 47 y/o female had a 1 week history of abdominal pain. She had been in good health prior to the onset of symptoms. Her only child had been delivered by c-section. On physical exam she was afebrile, had mild abdominal tenderness without rebound, WBC - 8,400 /mm³ and abdominal x-rays unremarkable. Selected images from her abdominal CT performed on this third visit to the ER demonstrate findings consistent with a closed loop obstruction. There is some ascites, a "whirled" appearance to the mesentery and a prominent loop. Surgical exploration found a closed loop obstruction of the distal ileum secondary to a large band like adhesion presumably from the previous c-section. Although the loop was "dusky" in appearance a resection was not necessary as it's appearance improved after relief of the obstruction. The patient had an uneventful recovery.
  1. Boudiaf M, Soyer P, Terem C, Pelage JP, Maissiat E, Rymer R. CT evaluation of small bowel obstruction. Radiographics 2001 May-Jun;21(3):613-24 PMID:11353110
  2. Furukawa A, Yamasaki M, Furuichi K, Yokoyama K, Nagata T, Takahashi M, Murata K, Sakamoto T. Helical CT in the diagnosis of small bowel obstruction. Radiographics 2001 Mar-Apr;21(2):341-55 PMID:11259698
  3. Makita O, Ikushima I, Matsumoto N, Arikawa K, Yamashita Y, Takahashi M. CT differentiation between necrotic and nonnecrotic small bowel in closed loop and strangulating obstruction. Abdom Imaging 1999 Mar-Apr;24(2):120-4 PMID:10024394
  4. Hashimoto M, Miyauchi T, Watanabe O, Tomura N, Watarai J. Computed tomographic appearance of closed-loop obstruction. Radiat Med 1995 Sep-Oct;13(5):205-8 PMID:8848554
  5. Balthazar EJ, Birnbaum BA, Megibow AJ, Gordon RB, Whelan CA, Hulnick DH. Closed-loop and strangulating intestinal obstruction: CT signs. Radiology 1992 Dec;185(3):769-75 PMID:1438761
    Comment in: Radiology. 1992 Dec;185(3):635-6
  6. Cho KC, Hoffman-Tretin JC, Alterman DD. Closed-loop obstruction of the small bowel: CT and sonographic appearance. J Comput Assist Tomogr 1989 Mar-Apr;13(2):256-8 PMID:2647796
  7. Balthazar EJ, Bauman JS, Megibow AJ. CT diagnosis of closed loop obstruction. J Comput Assist Tomogr 1985 Sep-Oct;9(5):953-5 PMID:4031175
  8. Maglinte DD, Herlinger H, Nolan DJ. Radiologic features of closed loop obstruction: analysis of 25 confirmed cases. Radiology 1991 May;179(2):383-7 PMID:2014278
  9. Snyder EN Jr, McCranie D. Closed loop obstruction of the small bowel. Am J Surg 1966 Mar;111(3):398-402 PMID:5907007
  10. Puthu D, Rajan N, Shenoy GM, Pai SU. The ileosigmoid knot. Dis Colon Rectum 1991 Feb;34(2):161-6 PMID:1993413
  11. Young WS, White A, Grave GF. The radiology of ileosigmoid knot. Clin Radiol 1978 Mar;29(2):211-6 PMID:639462
  12. Price J, Nolan DJ. Closed loop obstruction: diagnosis by enteroclysis. Gastrointest Radiol 1989 Summer;14(3):251-4 PMID:2731699
  13. Maglinte DD, Nolan DJ, Herlinger H. Preoperative diagnosis by enteroclysis of unsuspected closed loop obstruction in medically managed patients. J Clin Gastroenterol 1991 Jun;13(3):308-12 PMID:2066546
  14. Bezreh JS. Percutaneous catheter drainage of closed-loop small-bowel obstruction. AJR Am J Roentgenol 1983 Oct;141(4):797-8 PMID:6193697
  15. Miller BJ. Falciform ligament aperture causing intestinal strangulation. Can J Surg 1981 Jul;24(4):401-2 PMID:7272855

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