Further, during the workup on radiological examination X – the ray
abdomen was erect and showed distended bowel loops with few air-fluid
levels in the right lumbar region (shown with yellow arrowheads), which
was one of the positive findings of obstruction [Fig
1].
Figure 1: X-ray abdomen erect showed distended bowel
loops with few air fluid levels.
USG pelvis and abdomen showed a few tiny bowel loops (jejunal) dilated,
with a maximal diameter of 3.1 cm, exhibiting to and fro slow
peristalsis in the left peri-umbilical (lumbar) region. There are only a
few dilated small bowel loops with a maximum of 5 mm edematous
thickness. However, a Doppler study demonstrated normal vascularity in
the superior mesenteric vein and superior mesenteric artery. All the
above findings were suggestive of closed loop small bowel obstruction
and Para-duodenal hernia. Furthermore, the patient was scheduled for a
contrast-enhanced CT scan (abdominal and pelvis). Findings were
Distended small bowel loops (jejunum) with a max diameter of 2.9cm noted
in the left paraumbilical region, which is surrounded by a sac
containing mild fluid within with edematous bowel loops. There is no
evidence of dilatation of proximal bowel loops and No evidence of free
retroluminal air. The Mesentery surrounding the herniated bowel sac
appears engorged with a twist in the mesentery f/s/o internal hernia,
which is likely left paraduodenal hernia with the start of closed loop
obstruction.