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CT Abd SBO transition

There are multiple dilated loops of small bowel with largest diameter measuring 3.4 cm, extending to the mid pelvis transition zone where several loops of bowel are adherent to each other.
Distal to this site there is decompressed small bowel.
Fecalization of succus entericus is noted.
No closed-loop obstruction is evident.
There are multiple peritoneal nodules, largest one measuring 1.1 x 1.1 cm (Se: 3, Im: 41), not significantly changed from prior.
The oral contrast is seen at the level of stomach.
There is an enteric tube terminating in the stomach.
The liver, pancreas, adrenal glands and kidneys are normal.
There is perisplenic fluid collection consistent with ascites, improved from prior.
Perihepatic ascites has resolved.
There is no encapsulated, rim enhancing collection of fluid suggestive of an abscess.
There is no evidence of free air within the abdominal cavity.
The uterus is surgically absent.
The bladder is decompressed with a Foley catheter in place.

1. Small bowel obstruction with a transition zone within the mid lower pelvis likely due to peritoneal carcinomatosis versus postsurgical adhesions.
2. Unchanged peritoneal nodules.
Distended loops of small bowel are seen with intermittent areas of abrupt narrowing within a few areas of the ileum.
There may be a transition point towards the mid to distal portion of the ileum as the distal ileal loops are decompressed.
A small amount of fluid is seen adjacent to several of these distended ileal loops.
There is no bowel wall thickening.
No closed-loop obstruction is evident.
Stool fills the cecum and ascending colon.
The transverse and descending colon are decompressed.
Ascites is present scattered within the abdomen.
There is no free air.

IMPRESSION: Findings suggestive of a small bowel obstruction with possible transition point in the mid to distal ileum. Small amount of ascites.
There is an enteric tube terminating in the stomach.
No enteric contrast is seen.
There are dilated loops of small bowel extending to the site of the recent ileal resection.
Distal to this site there is decompressed small bowel and colon.
This is likely a transition point of a partial small bowel obstruction.
There is also a small amount of peritoneal fluid, which is expected postoperatively.
However, there is no encapsulated collection of fluid suggestive of an abscess.
There is minimal fat stranding around the surgical site, which is expected.
There is also a minimal amount of pneumoperitoneum seen superior to the liver, also not unexpected.

There is a 3.5 cm right renal sinus cyst.
There are also smaller simple renal cysts of the right superior pole, left lateral kidney and two in the left inferior pole.
The bladder is decompressed with a Foley catheter in place.
There is a ventral vertically oriented abdominal incision site with multiple surgical staples. Otherwise, the soft tissues and osseous structures are unremarkable.

IMPRESSION: Partial small bowel obstruction, with transition zone in the distal ileum, likely around the site of recent ileal resection. (0052-13156054)
Contrast is seen within the gastrointestinal tract to the level of the proximal jejunum.
There is fluid-filled dilatation of the mid to distal jejunum, largest dimension measuring approximately 3.4 cm.
There is a high-grade obstruction at the distal jejunum/proximal ileum with collapse of the small bowel distal to the transition point (image 55 of series 3; image 62 of series 602; and image 29 of series 601).
There is free intraperitoneal fluid visualized midline adjacent to several of the fluid-filled loops of small bowel extending posterior and to the right into the cul-de-sac adjacent to the rectum.
Additionally, there is a small amount of fluid surrounding the anterolateral liver capsule and at the inferior tip of the right hepatic lobe between the right kidney.
Postsurgical changes are again noted at the junction of the sigmoid colon and rectum.
There is a bowel containing ventral hernia.
The liver, pancreas, spleen, adrenal glands, and kidneys are normal.
The uterus and ovaries are surgically absent.
Multiple surgical clips are noted along the right common iliac and left aortic regions.
There are no pathologic masses in the abdomen or pelvis.
There is no lymphadenopathy.
There are airspace opacities within the dependent portions of the lung bases, likely representing atelectasis. The tip of the right chest port catheter is partially visualized within the cavoatrial junction. The visualized heart and great vessels are unremarkable.

1. High-grade small bowel obstruction at the distal jejunum/proximal ileum.
2. Nonspecific free intraperitoneal fluid, as above. This may be related to small bowel obstruction.
3. Ventral hernia.
Enteric tube tip is seen in the gastric lumen. Postsurgical changes compatible
with ileocecectomy are noted in the right lower abdomen. Multiple enlarged loops
of ileum are noted in the right lower abdomen, compatible with partial small
bowel obstruction, seen proximal to the area of postsurgical change. There is
free peritoneal fluid predominantly in the pelvis and lower abdomen. The colon
and proximal small bowel demonstrate normal course and caliber.

The liver, pancreas, spleen, adrenal glands, kidneys and bladder are
unremarkable. Few prominent mesenteric lymph nodes are noted in the right
lower abdomen. The osseous structures are unremarkable. Lung bases are clear.

Partial small bowel obstruction with a probable transition point in the right
lower abdomen in the area of ileocecectomy.
Comparison: None.

Technique: IV and oral contrast enhanced helical CT of the abdomen and pelvis
was performed from the lower thoracic margin through the symphysis pubis.
Coronal and sagittal reformats were provided.

Enteric tube is seen with the tip terminating in the stomach.

Stacked and dilated loops of small bowel are demonstrated, with collapsed small
bowel visible in the right lower quadrant. However, oral contrast is seen
translating to the region of the distal transverse colon. Dilated, tortuous
fluid collection is demonstrated in the right adnexa, consistent with known
hydrosalpinx. Minimal free fluid is demonstrated in the pelvis.

There is no lymphadenopathy. Visualized osseous structures of the thorax and
pelvis are normal appearing. There is a soft tissue density with central
calcification demonstrated in the right lower lobe. This most likely represents
a granuloma.

1. Partial small bowel obstruction.
2. Hydrosalpinx.
3. No evidence of abscess formation or perforation as queried.