0:00

Okay.

0:01

Continuing on our theme of bowel

0:03

obstruction, we have another contrast

0:05

enhanced CT scan of the abdomen and pelvis.

0:07

You'll notice a tiny bit of intrahepatic

0:09

biliary ductal dilatation in this patient.

0:12

There's also an enlarged bile duct, but the patient

0:13

is status post-cholecystectomy, as seen by these clips

0:16

here in the portal hepatic region, so that's probably

0:18

just a reservoir effect in this patient. As we come down,

0:23

we're going to see some dilatation of the small bowel.

0:26

Again, this dilated small bowel enhances nicely,

0:29

so no evidence of ischemic change here. Coming

0:32

deep into the pelvis, we're going to try to figure

0:35

out what the cause of the small bowel obstruction

0:37

is, and then we come deep into the pelvis.

0:39

We start to see that this small bowel, intraluminal

0:41

contents, change to this kind of frothy appearance.

0:45

We like to refer to this as fecalization or

0:48

poopafication of the small bowel.

0:50

That means that the internal contents within the

0:52

small bowel have become somewhat turbid or stagnant,

0:55

and that the fluid has been reabsorbed from the

0:58

lumen, leading to this kind of fecalized appearance.

1:01

This is often where you're going to find the

1:03

obstructing point of your small bowel obstruction.

1:05

It's right at the level of that fecalization.

1:07

So I usually follow a small bowel obstruction

1:09

down to that region and then try to find

1:11

out where the, um, decompressed loops are,

1:14

which is right here along this left pelvic sidewall.

1:17

This patient had had prior GYN surgery.

1:20

So most assuredly, this is a small adhesion

1:22

causing a small bowel obstruction.

1:25

Now, I like to talk about whether

1:26

or not it's low or high grade.

1:27

It's kind of hard to tell sometimes, but things

1:29

here that are reassuring are the fact that we

1:31

don't see any ascites within the abdomen.

1:34

It looks like it's a simple small bowel obstruction

1:36

with a single point of obstruction and that

1:38

there's only a short segment of fecalized bowel.

1:41

So I would call this a simple low-grade small bowel

1:44

obstruction resulting from likely adhesive disease

1:48

down in the deep pelvis along the left pelvic

1:51

sidewall, and that's how I would dictate this case.