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CT Abd RnY, Ileus

Findings: The patient has undergone prior Roux-en-Y gastric bypass. Surgical staple lines and clips are seen at the gastrojejunostomy. The gastric remnant contains a small amount of fluid within its lumen without luminal contrast. The jejunojejunostomy is located in the right hemiabdomen, demonstrating a patent appearance. There are multiple fluid and contrast filled borderline dilated loops of small bowel measuring up to 3.8 cm in diameter and air-fluid levels. There is no clearly defined transition point. There is gas throughout the colon. There is no pneumoperitoneum. There are 9 mm hypodense lesions in the left hepatic lobe and dome of the liver, too small to characterize. The liver is otherwise unremarkable. The pancreas, spleen, adrenal glands, kidneys and bladder are normal. There is a trace amount of fluid in the pelvis. There is a chunky calcification within the left fundal myometrium, measuring 1.5 cm, likely a degenerating fibroid. Mild degenerative changes are seen in the spine with transitional anatomy at the lumbosacral junction. Conclusion: 1. Multiple fluid and contrast filled borderline dilated loops of small bowel in the setting of colonic gas may represent gastroenteritis, ileus versus early or partial small bowel obstruction. Followup plain films are advised. 2. Right upper quadrant positioning of the jejunojejunostomy is somewhat atypical in location. Correlate with surgical history to exclude internal hernia.