The
n e w e ng l a n d j o u r na l
of
m e dic i n e
images in clinical medicine Lindsey R. Baden, M.D., Editor
Mechanical Small-Bowel Obstruction A
Jacob Antonsen, M.D. Herlev University Hospital Herlev, Denmark
[email protected]
Jorgen Tilma, M.D. Aarhus University Hospital Aarhus, Denmark
B
A
57-year-old woman was admitted to the emergency department with sudden-onset upper abdominal pain and vomiting. The patient’s medical history was notable for type 1 diabetes and laparoscopic tubal sterilization. Computed tomography (CT) revealed small-bowel volvulus with dilated small bowel rotated around its blood supply (Panels A and B). There were no signs of free air or fluid and no indication of bowel ischemia on the CT scan. Explorative laparotomy revealed signs of strangulation of the small bowel 1 m from the ligament of Treitz. The bowel was viable, and no resection was performed. The patient was discharged in good condition 3 days later.
DOI: 10.1056/NEJMicm1312048 Copyright © 2014 Massachusetts Medical Society.
e12
n engl j med 371;9
nejm.org
august 28, 2014
The New England Journal of Medicine Downloaded from nejm.org at UAB LISTER HILL LIBRARY on July 27, 2015. For personal use only. No other uses without permission. Copyright © 2014 Massachusetts Medical Society. All rights reserved.
n e w e ng l a n d j o u r na l
of
m e dic i n e
images in clinical medicine Lindsey R. Baden, M.D., Editor
Mechanical Small-Bowel Obstruction A
Jacob Antonsen, M.D. Herlev University Hospital Herlev, Denmark
[email protected]
Jorgen Tilma, M.D. Aarhus University Hospital Aarhus, Denmark
B
A
57-year-old woman was admitted to the emergency department with sudden-onset upper abdominal pain and vomiting. The patient’s medical history was notable for type 1 diabetes and laparoscopic tubal sterilization. Computed tomography (CT) revealed small-bowel volvulus with dilated small bowel rotated around its blood supply (Panels A and B). There were no signs of free air or fluid and no indication of bowel ischemia on the CT scan. Explorative laparotomy revealed signs of strangulation of the small bowel 1 m from the ligament of Treitz. The bowel was viable, and no resection was performed. The patient was discharged in good condition 3 days later.
DOI: 10.1056/NEJMicm1312048 Copyright © 2014 Massachusetts Medical Society.
e12
n engl j med 371;9
nejm.org
august 28, 2014
The New England Journal of Medicine Downloaded from nejm.org at UAB LISTER HILL LIBRARY on July 27, 2015. For personal use only. No other uses without permission. Copyright © 2014 Massachusetts Medical Society. All rights reserved.
