Closed loop bowel obstruction

CASE Nam, 52 tuổi, vào viện đau bụng quặn cơn, nôn nhiều, diễn biến ngày Tiền sử: Mổ nang ống mật chủ cách năm Mổ VRT 25 năm Khám LS: Dấu hiệu Von Wahl (+): bụng chướng lệch sang mạn sườn trái, quai ruột nổi, căng, không di động, ấn đau Nghe: nhu động ruột PUTB (+), CUPM (-) CT Phẫu thuật CASE Nữ, 36 tuổi, vào viện đau bụng thượng vị âm ỉ, không nôn, không buồn nôn Sau vào viện 5h đau quặn hố chậu phải, buồn nôn Không sốt Tiền sử mổ đẻ cách năm Khám: PUTB HCP(+), CUPM (+) CT Depend on the amount of obstruction at the two stenoses and the time before the patient gets to CT and surgery In most cases both the proximal bowel and the closed loop are dilated Sometimes there is only dilatation of the proximal bowel or only of the closed loop When the obstruction is very acute and there is no time delay, the bowel may not be dilated at all, which can make the diagnosis difficult Small bowel feces sign This case: - The small bowel is not dilated Go down to the pelvis you see a dilated loop of bowel with inhomogeneous content Deep down in the pelvis there is a C-shaped dilated bowel indicating a closed loop obstruction The SBFS is a very useful sign as it is seen at the zone of transition from normal to obstructed bowel and thus facilitating identification of the point and the cause of the bowel obstruction Ischemia Complication - Increased bowel-wall attenuation on unenhanced CT images is a specific sign for ischemia complicating SBO comparison with the attenuation of the neighboring normal loops, which has been reported to range from 10 to 20 HU (Venous congestion can cause - hemorrhagic venous infarction of the bowel wall) Enhancement: hyper -> hypo -> absent Wall thickening – nonspecific Pneumatosis and portomesenteric gas Ascites Volvulus In the CT, signs of closed loop obstruction are associated with a “whirl sign” The “whirl sign” corresponds to the winding of the mesenteric vessels and mesos that converge towards the mesenteric point of torsion First we see a collapsed descending colon and a non-dilated ascending colon, so this cannot be a sigmoid volvulus Secondly, we see a beak-like structure in the right lower quadrant which is where the bowel is twisted Internal hernia — Paraduodenal: —Small bowel mesentery–related hernia —Greater —Lesser omentum–related hernia sac hernia —Transverse — 53% (Left: 40%- Right: 13%) mesocolon–related hernia Pericecal hernia —Sigmoid … mesocolon–related hernia Summary - Two points along the course of a bowel are obstructed Usually secondary to adhesions , volvulus, or hernia Closed loop obstructions are at higher risk than non-closed loop obstructions for strangulation (compromised blood supply) or distension-related ischemia, resulting in intestinal necrosis and perforation CT: Location, Complications,Cause Emergency surgery References - - https://radiologyassistant.nl/abdomen/bowel/closed-loop-in-small-bowel-obstruction https://radiopaedia.org/articles/closed-loop-obstruction https://www.sciencedirect.com/science/article/pii/S2211568413003318 https://radiopaedia.org/articles/internal-hernia ... HCP(+), CUPM (+) CT Closed loop bowel obstruction Definication - Closed loop obstruction is a specific type of bowel obstruction in which two points along the course of a bowel are obstructed,... absent bowel sounds Shock X-ray Ultrasound CT The CT-presentation of a closed loop obstruction in the small bowel depends on two things: Length of the bowel segment that forms the closed loop Orientation... proximal bowel and the closed loop are dilated Sometimes there is only dilatation of the proximal bowel or only of the closed loop When the obstruction is very acute and there is no time delay, the bowel