Mr A, 19 year old, underlying ileal atresia done bowel resection + primary anastomosis in 2003 then closed jejunostomy – open surgery.
In 2019, relaparatomy and adhesiolysis.
The diagnosis being intestinal obstruction secondary to adhesion as noted from CT scan done pre operatively- predominantly at the left hypochondrium.
Patient presented with symptoms of vomiting for 4 days since discharged- food and bilious vomiting.
3 days later, still unable to tolerate orally – vomiting, nil by mouth for 2 days, abdomen distended, subjecting him for second CT abdomen with oral contrast.
Preliminary AXR shows persistent oral contrast in the transverse colon with vulvulae conniventes of the central small bowel.
Upon the investigating CT post operatively done 2 weeks later,
Ryles tube insitu in the stomach with underdistension of the stomach.
The stomach antrum and pylorus is compressed whereas the jejunum and proximal ileum is distended. The distal ileum and terminal ileum are collapsed with oral contrast within.
Smooth ileal wall thickening. Unable to locate suture material from appendicectomy.
The ascending, transverse and descending colon are not dilated with dense old rectal contrast. There is a short segment polypoidal soft tissue growth or thickening at the proximal rectum causing luminal narrowing stenosis. This could represent thick haustra.
An abnormal contour of the small bowel segment at left iliac fossa and within the pelvic with dense materials likely suture.
Compression of the mid segment of the sigmoid colon likely from the adherence from the left side of the small bowel. Rest of the sigmoid colon is not dilated.
No contrast leak.
However, there is a new rim enhancing collection at the right iliac fossa extending to the right side of the pelvis at the area of concern.
