Independent Imaging Review by the Surgical Team Resulted in Prompt Surgical Management of CL-SBO Avoiding Ischemia and Bowel Resection

Tony AbdelMaseeh* and Alexander S Thomas

Family Medicine Hospitalist at UPMC, Pittsburgh, USA Complex General Surgery Oncology Fellows, UPMC, Pittsburgh, USA

^*Correspondance to: Tony AbdelMaseeh 

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Abstract:

Closed loop small bowel obstruction (CL-SBO) is a high-risk subtype of SBO where obstruction occurs in 2 points along the bowel. It carries a high risk of strangulation and distention related ischemia (due to lack of a route for decompression) resulting in intestinal necrosis and perforation if not detected and managed early. We present a case of CL-SBO due to fused epiploic appendages of the sigmoid colon. A 73-year-old man with no prior history of abdominal surgery presented with 3 days of generalized abdominal pain, nausea, vomiting and constipation. Initial CT showed dilated bowel loops with a transition point in the central lower abdomen. A closer review by the surgery team raised high suspicion for CL-SBO, prompting repeat imaging which confirmed the suspicion. Intraoperative findings included CL-SBO without ischemia, which was managed by lysis of the adhesions. The postoperative course was uncomplicated.

Keywords:

Closed loop, Internal hernia, Epiploic appendages

Cite the Article:

AbdelMaseeh T, Thomas AS. Independent Imaging Review by the Surgical Team Resulted in Prompt Surgical Management of CL-SBO Avoiding Ischemia and Bowel Resection. Ann Clin Case Rep. 2025; 10: 2793..