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Key Image

Contrast enhanced CT images of the abdomen and pelvis in the coronal and axial planes

Key Findings

CT abdomen and pelvis axial and coronal images demonstrate multiple loops of dilated small bowel, >2.5 cm diameter (red arrows). There is a loop of distal ileum herniated through the right inguinal canal (yellow arrows). The incarcerated bowel demonstrates bowel wall thickening and surrounding edema (white arrow). The small bowel and colon distal to the obstruction is nearly entirely collapsed (blue arrow).

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Diagnosis

Small Bowel Obstruction / Right Inguinal Hernia

Discussion

This patient has a loop of distal small bowel that has become invaginated in a right inguinal hernia. The loop of bowel is not reducible and the patient underwent reparative surgery.
The loop of bowel within the hernia demonstrates wall enhancement and surrounding fluid. Note the large proximal loops of small bowel. The diameter of these loops measured up to 3.5 cm. There is a short segment of ileum after the obstruction that is decompressed prior to the ileocecal valve. The entire colon is decompressed. It is important to realize that the severity of bowel obstruction is measured by the degree of decompression in the distal loops, not the width of the proximal loops. To diagnose a small bowel obstruction, there should be at least a few loops of bowel with diameter greater than 2.5 cm. The appearance of the scout radiograph prior to CT exam (available in case menu) is diagnostic for a small bowel obstruction.

References / Resources

Additional Information:

1. Dahnert*: Hernia 856, Obstruction 775-779
2. Primer*:
3. Related Article:

   Silva, AC "Small Bowel Obstruction: What to Look For." Radiographics 2009: 29, 423-439.

   Boudiaf, M. "CT Evaluation of Small Bowel Obstruction." Radiographics 2001: 21, 613-624.

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