70-year-old female:
* Presents with acute abdominal pain
* Previous history adnex extirpation and appendectomy
* No raised inflammatory parameters
* No peristalsis
* CT abdomen with IV contrast
What do you see?
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Dilated small bowel loops, radiating distribution (“Bunch of grapes”) with impressive mesenterial venous engorgement and edema in the centre. Ascites perihepatic and in Douglas. Loss of bowel enhancement.
What is the most likely diagnosis?
Closed loop obstruction with bowel ischemia.
Teaching point
Seek for 2 (!) calibre changes next to each other to confirm SBO on basis of Closed loop obstruction.
Peroperative 1 meter of necrotic small bowel was resected.
