https://www.learnabdominal.com/abdominal-ct-101

Presentation: Nausea, vomiting, abdominal pain. History of small bowel resection.

Key findings (GI tract in anatomic order):

• Stomach is moderately distended.
• Several loops of proximal small bowel are not dilated. 
• Mid through distal small bowel loops dilated up to 3.4 cm.
• Fecalization of several loops of distal small bowel content leading to the transition point.
• Small bowel obstruction with transition point in the right loawer quadrant at the site of enteroenteric anastomosis.
• Distal small bowel after obstruction is decompressed.
• Transverse and descending colon are decompressed. 

Diagnosis: Small bowel obstruction with transition point in the right lower quadrant.

Comments: Fecalized contents leading to the point of obstruction suggest that this is low-mid grade rather than high-grade, as fecalized contents would not have time to form (water resorption) in the setting of a high grade obstruction.

The proximal small bowel is not dilated, which could be related to vomiting/evacuation or lower grade obstruction.

Management: Surgical consultation.

Discussion:

Fecalized small bowel content can be very helpful to locate the site of obstruction, and often indicates a low-grade or developing obstruction, as there is enough time for increased resorption of water content to occur.

In this case, the fecalized contents lead to the transition point, which is at the enteroenteric anastomosis and likely due to adhesions.

Patient was successfully managed with nasogastric decompression and slow advancement of diet.

Supplemental mini-lecture on SBO:

Diagnosing small bowel obstruction on abdominal CT