Figure 10.

Passed challenge in an immediate post-operative patient who initially presented with rapidly progressive SB obstruction due to a focal closed loop component secondary to adhesions. Underwent lysis of adhesions but no resection. Presented again 5 days later with increasing abdominal pain, nausea, and emesis. (a, b) CT with i.v. and no oral contrast from repeat admission demonstrated diffusely dilated small bowel and focally thickened loops (arrows in a) in the right lower quadrant which corresponded to the site of prior closed loop. (c) WSC challenge was initiated and demonstrated successful transit into the colon on 8-h AXR with some persistent contrast in mildly dilated SB. Overall, this was felt to be most suggestive of post-operative ileus. Patient was treated successfully with non-operative management. AXR, abdominal radiographs; SB, small bowel; WSC, water-soluble contrast.