Small-Bowel Obstruction with Imaging Features of Strangulation and Bowel Ischemia: A Case Report Highlighting the Role of Computed Tomography in the Acute Abdomen

Orjiakor Chioma, George Ene Ekanem, Kalesanwo Emmanuel Ayomide, Amos Faniya Araunah

Abstract: Introduction: Small-bowel obstruction (SBO) is a frequent source of acute abdominal pain and poses a significant diagnostic challenge in emergency medicine and radiology. While many instances can initially be treated conservatively, bowel strangulation and ischemia are potentially fatal complications that demand prompt identification and surgical management. Computed tomography (CT) plays a central role in assessing suspected SBO, as it can confirm the diagnosis, locate the transition point and possible cause, and reveal signs suggesting compromised bowel viability. Case Presentation: A patient experienced acute, worsening abdominal pain along with nausea, vomiting, abdominal swelling, and reduced passage of stool and gas. Physical examination showed abdominal distension and localized tenderness. Laboratory tests revealed abnormalities suggestive of an acute intra-abdominal condition. Given the clinical picture and suspicion of mechanical obstruction, contrast-enhanced CT of the abdomen and pelvis was performed. CT revealed multiple dilated, fluid-filled small-bowel loops with a distinct transition point. The affected bowel exhibited abnormal wall enhancement and thickening, associated mesenteric edema, free intraperitoneal fluid, and engorgement of mesenteric vessels. The presence of mechanical obstruction along with secondary bowel-wall and mesenteric abnormalities raised suspicion of strangulation with impaired bowel perfusion. These findings were immediately relayed to the treating team, and the patient underwent urgent surgical assessment and operative intervention. Conclusion: This case highlights the value of systematic CT evaluation in patients with suspected SBO. Identifying a transition point confirms mechanical obstruction, while evaluating bowel-wall enhancement, mesenteric vessels, mesenteric edema, free fluid, pneumatosis, and other secondary signs is crucial for detecting threatened bowel viability. Early recognition and communication of these findings may enable timely surgical intervention and enhance patient outcomes.

Keywords: computed tomography; small-bowel obstruction; bowel ischemia; bowel strangulation; acute abdomen; emergency radiology; diagnostic imaging

How to Cite?: Orjiakor Chioma, George Ene Ekanem, Kalesanwo Emmanuel Ayomide, Amos Faniya Araunah, "Small-Bowel Obstruction with Imaging Features of Strangulation and Bowel Ischemia: A Case Report Highlighting the Role of Computed Tomography in the Acute Abdomen", Volume 15 Issue 9, September 2026, International Journal of Science and Research (IJSR), Pages: 732-738, https://www.ijsr.net/getabstract.php?paperid=MR26907210327, DOI: https://dx.doi.org/10.21275/MR26907210327

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