0:00

Okay, so here we go.

0:02

Another contrast-enhanced CT scan.

0:04

But let's not forget to look at the scout image.

0:06

'Cause sometimes a scout image can tell a thousand

0:09

other axial images just from the single image here.

0:12

So if we look at this scout image, we can already

0:15

tell that in the central aspect of the abdomen

0:17

we have multiple dilated loops of small bowel.

0:20

10 00:00:20,400 --> 00:00:22,205 Look at it, you can see that those nice valvulae conniventes,

0:22

or plicae circulares, should you call them

0:24

that. Those nice folds of the small bowel are

0:26

seen all the way across this dilated lumen.

0:29

It's in the central abdomen, and

0:31

you don't have much colonic gas.

0:33

Very, very little colonic gas.

0:34

So this appearance on the scout is in

0:36

keeping with a small bowel obstruction.

0:39

It's time to look at the CT scan and try

0:41

to determine if we can find the cause.

0:43

So coming down, this patient has

0:45

some tiny imperfections baseline.

0:47

You can see that the liver here

0:48

is a little nodular in appearance.

0:51

There's, um, hypertrophy of

0:52

the left lobe and the caudate.

0:54

So this is a patient with underlying cirrhosis.

0:56

We can even see a number of

0:58

esophageal varices here in the upper.

1:01

Aspect of the abdomen going into, uh, the thorax.

1:05

We have a large volume of ascites as well, so the

1:08

patient has, you know, some tiny imperfections that

1:10

are a little bit abnormal, but we're going to look for

1:12

the cause of this patient's bowel obstruction as well.

1:15

As we come down, we see all

1:17

of these loops of small bowel.

1:18

They're very dilated, fluid-filled.

1:21

We still have nice enhancement

1:22

of the walls of the small bowel.

1:26

Coming back down, we can see that the small bowel

1:29

suddenly herniates into a classic umbilical hernia.

1:33

And when the bowel goes into the hernia,

1:35

it's very dilated with fluid, and on

1:37

its way out is completely decompressed.

1:39

So this is an umbilical hernia causing

1:42

obstruction to the small bowel.

1:44

Notice.

1:45

The bowel within the hernia has nice enhancement,

1:47

so it does not look to be ischemic in any way.

1:51

But it is indeed causing the obstruction.

1:54

You can imagine that decompressing that hernia

1:57

would do the patient some service, and they

2:00

would feel much better as a result of a hernia

2:03

causing small bowel obstruction in a patient with

2:06

cirrhosis and underlying large volume ascites.