Ultrasound in the diagnosis of small bowel obstruction secondary to an incarcerated jejunal loop in Morison’s pouch

Charlotte Derr,Matthew Fucarino

doi:10.1007/s13089-011-0075-2

Abstract

Abstract A few authors have published articles on unusual cases of internal hernias; however, there are no reports in the literature of a hernia arising from a right-sided retroperitoneal defect resulting in the incarceration of small bowel in Morison’s pouch. This case illustrates how point-of-care ultrasound was used to diagnose a small bowel obstruction in an atypical location.

Highlights

A 26-year-old man presented to the emergency department (ED) with a 3-h history of sharp upper abdominal pain
As the patient was drinking, the oral contrast in preparation for the second CT a pointof-care ultrasound of the right upper quadrant and right flank region was performed by an ED physician
Internal hernias are rare, accounting for \1% of all instances of intestinal obstruction and leading to only 0.5–4.1% of cases of acute intestinal obstruction caused by hernias [1]

Summary

Introduction

An abdominal ultrasound of the right upper quadrant (performed by a sonographer in the radiology department) was interpreted as limited secondary to overlying bowel gas (Fig. 1), but showed no evidence of gallstones, gallbladder wall thickening, common bile duct dilatation or pericholecystic fluid. On re-examination, the patient’s pain had localized to the right flank region and the decision was made to order a non-contrast CT of the abdomen and pelvis to evaluate for possible kidney stone. As the patient was drinking, the oral contrast in preparation for the second CT a pointof-care ultrasound of the right upper quadrant and right flank region was performed by an ED physician.

Results

Conclusion