Figure 1.

Passed challenge in a 31-year-old patient with prior history of right lower quadrant pancreas transplant a few years earlier presented with new abdominal pain. (a) Initial presentation CT with minimally dilated small bowel including ‘small bowel feces’ sign (arrow) suspicious for possible developing partial small bowel obstruction. Patient was initially managed non-operatively at an outside facility but was transferred due to non-resolution. (b) Repeat CT with i.v. contrast, completed 4 days after the first scan, demonstrates increasingly dilated and fluid-filled small bowel, as well as possible transition point in the right lower abdomen (dashed arrow). WSC challenge was initiated and 8-h AXR (c) demonstrated successful contrast transit into the colon (arrow) with persistent mildly dilated small bowel (dashed arrow). Subsequent 24-h AXR (d) demonstrated additional contrast transit to the colon (arrow) and improving small bowel dilatation. Given the success of the WSC challenge, an initial nasogastric (NG) tube clamp trial and subsequent diet advancement was completed. Non-operative management was successful with return of bowel function and patient discharge the next day. AXR, abdominal radiographs; WSC, water-soluble contrast.