Closed loop small bowel obstruction
? Bowel obstruction. Several previous intra-abdominal surgeries. Renal transplant patient. Vomiting and absolute constipation.
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There is a thick walled poorly enhancing loop of small bowel in the pelvis on the left with 2 transisition points and surrounding fat stranding. The small bowel proximally is dilated and small bowel distally is collapsed. There is suture material in the caecum. The large bowel is not dilated.
Moderate volume ascites. No free gas or pneumatosis. Normal lung bases. Degenerative bony change.
The patient proceeded to surgery immediately. Adhesions were found and ileum was resected.
PATHOLOGY: Macroscopically the mucosal folds were attenuated and the mucosa dusky with exudate. The bowel wall was up to 7mm thick and the serosa was dark brown to grey. Microscopically the sections showed ulceration and haemorrhage. No necrosis. Abundant acute inflammation. The submucosa was oedematous with inflammatory changes. The blood vessels were congested. Diagnosis: Acute ischaemia with haemorrhage. The resection margins are viable.