case_images: PMC11830378_01
case_images: CT enterography (coronal view) with a distended stomach and stricture at the pyloric channel (red arrow) consistent with gastric outlet obstruction.
case_images: cureus-0017-00000077585-i01.jpg
case_images: PMC11830378_01_cureus-0017-00000077585-i01.jpg
case_images: FIG1
case_images: Diagnostic evaluations, including endoscopy and imaging, confirmed significant strictures at the ileocecal valve and pyloric channel, along with fibrotic narrowing and minimal active inflammation (Figure 1).
case_images: CT abdomen and pelvis with contrast (coronal view) shows diffuse dilated small bowel loops, a largely decompressed colon, and evidence of a transition zone near the anastomosis (red arrow). The transition zone represents the point where normal-caliber bowel transitions to dilated bowel, indicating the site of obstruction and serving as a critical finding in identifying the location of the underlying pathology.
case_images: cureus-0017-00000077585-i02.jpg
case_images: PMC11830378_01_cureus-0017-00000077585-i02.jpg
case_images: FIG2
case_images: A CT scan was obtained, which showed evidence of a small bowel closed loop obstruction in the central portion of the abdomen, within the mesentery, proximal to the surgical anastomosis (Figures 2, 3).
case_images: CT abdomen and pelvis with contrast (axial view) with evidence of a small bowel closed loop obstruction (red arrow) seen in the central portion of the abdomen in the mesentery, proximal to the surgical anastomosis.
case_images: cureus-0017-00000077585-i03.jpg
case_images: PMC11830378_01_cureus-0017-00000077585-i03.jpg
case_images: FIG3
case_images: A CT scan was obtained, which showed evidence of a small bowel closed loop obstruction in the central portion of the abdomen, within the mesentery, proximal to the surgical anastomosis (Figures 2, 3).
case_images: Intraoperative photo showing a mesenteric swirl (yellow arrow), a hallmark sign concerning for an internal hernia. This finding represents twisted mesenteric vessels, indicating bowel loops passing through a mesenteric defect, which was confirmed during surgery and subsequently repaired.
case_images: cureus-0017-00000077585-i04.jpg
case_images: PMC11830378_01_cureus-0017-00000077585-i04.jpg
case_images: FIG4
case_images: The findings revealed an internal hernia of the right colon and terminal ileum through the ileocolic mesocolon defect (Figure 4).