Small bowel obstruction

Gallstone ileus is a rare complication of cholelithiasis, but an established cause of mechanical small bowel obstruction in elderly patients. It is associated with high morbidity and mortality as most patients are elderly with multiple comorbidities. Surgery of choice is enterolithotomy.     

Small bowel obstruction and previous gynecologic surgery

We reviewed the cases of women admitted to LSU Medical Center in Shreveport with the diagnosis of "small bowel obstruction" from Jan 1, 1975 to June 30, 1981. Review of the charts of patients who had exploratory laparotomy for relief of the obstruction showed that 83% of them had had previous abdominal surgery. Furthermore, 67% of the patients had had an abdominal hysterectomy. In 100% of the cases of obstruction after abdominal hysterectomy, there were adhesions to the site of reperitonealization or to the anterior abdominal wall. This study shows a higher incidence of small bowel obstruction after gynecologic surgery than has been previously reported.     

Small bowel obstruction and the gastrografin challenge

Abdominal Radiology - The “gastrografin challenge” has been used for decades in the evaluation of small bowel obstruction (SBO). This type of study involves enteric administration of a...     

Small bowel obstruction secondary to Crohn disease

We investigated the computed tomographic (CT) findings in patients with small bowel obstruction (SBO) and Crohn disease (CD). Fourteen patients, seven men and seven women (mean age, 41.3 years), were retrospectively reviewed. All presented with clinical symptoms and signs of SBO. Eleven had a history of CD, whereas three experienced the bowel obstruction as the first manifestation of the disease. On CT, features of complete SBO were seen in nine patients, whereas incomplete obstruction was found in the other five. One patient had CT findings of an adhesive obstruction. The other 13 were diagnosed as having CD-related SBO; a markedly stenotic bowel segment caused the obstruction in one patient, and a thickened-wall small bowel segment with luminal narrowing was evident at the transition zone in the other 12. The mural thickening had a target appearance in seven and homogeneous thickening in the other five. Additional thickened bowel segments were found in five patients and mesenteric involvement was found in 10. Five patients were treated conservatively, and the other nine underwent surgery (one with adhesiolysis only). Resection of the stenotic bowel was performed in six patients and stricturoplasty was done in the other two, with associated intestinal biopsy in one of these two patients. Histopathology revealed findings of active on chronic disease in all. CT is frequently performed for suspected SBO, so radiologists should be aware of the diagnosis of CD, because SBO may be its first manifestation. Alternatively, radiologists can accurately diagnose a CD-related obstruction in a patient with known CD and differentiate it from an obstruction due to adhesions. Patient management in these cases, however, is based most often on the clinical condition.     

Small bowel obstruction caused by massive fibroids

A 44-year-old woman presented to the Emergency Department with abdominal pain. She had a history of fibroids and no prior surgeries. Ultrasonography and CT imaging revealed a small bowel obstruction and massive uterine fibroids. The patient required laparotomy to relieve the intestinal obstruction after conservative therapy failed. Massive uterine fibroids is a rare cause of small bowel obstruction which requires the vigilance of Emergency Medicine physicians.     

Small bowel obstruction due to an impacted endoscopy capsule

Capsule endoscopy (CE), a recently introduced technology, offers important benefits for evaluation of small bowel pathology as compared to traditional radiologic and endoscopic studies. The most striking complication of this modality is capsule retention, which may obligate invasive retrieval. The radiologist should be aware of the natural course, presentation, diagnostic evaluation, and treatment options for this retained foreign body.     

Small bowel obstruction caused by endometriosis in a postmenopausal woman

We report a rare case of small bowel obstruction (SBO) caused by endometriosis in a postmenopausal woman. A 54‐year‐old postmenopausal woman presented with severe abdominal pain and vomiting. Before menopause, she sometimes had abdominal pain associated with menses. Axial multi‐dimensional CT images revealed a SBO with small nodules near the terminal ileum. The obstruction was diagnosed as being caused by small bowel endometriosis. Curved planar reconstruction images showed a complicated obstruction of the small intestine 15 cm from the terminal ileum. Based on the stenotic lesion, a SILS procedure was performed. The patient's SBO diagnosis was histologically confirmed as being caused by small bowel endometriosis. SILS was deemed to be a safe, feasible procedure for treating this bowel obstruction. Curved planar reconstruction images were useful in preoperative imaging and diagnosis of SBO, especially as they were able to highlight the constricting legion.     

Small bowel obstruction related to left-side paraduodenal hernia: CT findings

The role of computed tomography in the evaluation of patients with small bowel obstruction has been extensively described in the current literature. We report a rare case of small bowel obstruction related to a surgically proved left-side paraduodenal hernia detected on abdominal computed tomography.     

Small bowel obstruction related to left-side paraduodenal hernia: CT findings

The role of computed tomography in the evaluation of patients with small bowel obstruction has been extensively described in the current literature. We report a rare case of small bowel obstruction related to a surgically proved left-side paraduodenal hernia detected on abdominal computed tomography.     

Small bowel obstruction from an antacid bezoar: a ranitidine-antacid interaction?

A 63-year-old man had an acute small bowel obstruction while being treated with ranitidine and self-prescribed antacid. On exploration, a firm mass, chemically similar to the ingested antacid, was found impacted in the terminal ileum. We believe the effect of ranitidine on gastric secretory volume was the cause of the antacid concretion.     

Small bowel

MR imaging, using modern equipment and a rigorous technical approach, can offer detailed morphologic information and functional data on the small bowel. The optimal study technique is debatable, although the oral administration of contrast material as a first-line approach is less expensive, faster, easier to perform, and better tolerated by patients. MR enteroclysis might be reserved for selected cases as a second-line study. The major clinical indication is the evaluation of patients who have suspected or known Crohn's disease. The absence of ionizing radiation, considering the young age of most of the patients and the frequency of the examinations, is an important advantage over other techniques (radiograph and CT enteroclysis).     

Small bowel obstruction due to a right-sided paraduodenal hernia: a case report

Small bowel obstruction (SBO) diagnosed with abdominal computed tomography (CT) has been extensively studied in radiology literature. We present a case report of SBO due to a rare right-sided paraduodenal hernia diagnosed preoperatively on a non-contrast CT and confirmed surgically.