An 85-year-old male with abdominal pain and previous gastric surgery

Abstract

An 85-year-old Caucasian male presented as an emergency to hospital with a 3-week history of increasing colicky abdominal pain, anorexia and constipation. He had undergone an operation for peptic ulcer disease over 30 years previously. On examination the patient had a distended abdomen, which was tympanic to percussion. An upper midline laparotomy scar was apparent. A clinical diagnosis of small bowel obstruction was made. A CT scan of the abdomen and pelvis was requested. Selected images of the portal venous phase CT examination of the abdomen and pelvis with oral and intravenous contrast are shown in Figure 1. What do they demonstrate? What is the differential diagnosis? Figure 1. Selected coronal, axial and sagittal images from a portal venous phase study of the abdomen and pelvis. (a) Thickened segment of distended small bowel with intramural gas (arrows), (b) intraluminal curvilinear focus of calcification (arrow), (c) intraluminal ...