Sequential stenotic strictures of the small bowel leading to obstruction

Abstract

Small bowel obstructions (SBOs) are primarily caused by adhesions, hernias, neoplasms, or inflammatory strictures. Intraluminal strictures are an uncommon cause of SBO. This report describes our findings in a unique case of sequential, stenotic intraluminal strictures of the small intestine, discusses the differential diagnosis of intraluminal intestinal strictures, and reviews the literature regarding intraluminal pathology.

Figure 1

CT scan of the abdomen. A CT scan of the abdomen revealed an SBO with dilation of small-intestinal loops, and a transition point in the mid-jejunum. A distended small was observed anteriorly of the air fluid level, and distal to this, a dilated loop and cross section was filled with feces, the so-called small bowel feces sign, which is indicative of SBO. Distal to the obstruction, there was a clear transition point in the mid-jejunum.

Figure 2

Gross specimens. Seventy-six centimeter segment of small intestine. On gross examination, fat surrounded the serosal surface of the intestine at irregular intervals, at the mesenteric border (A). Associated with these deposits of fat were 14 areas of mucosal stricture. In the normal intestine, the luminal diameter ranged from 4.7 to 9.5 cm. In the areas of luminal constriction, the diameter was 0.7 to 1.0 cm (B, C).

Figure 3

Microscopic image. On microscopic examination, the intestinal webs contained mucosa and submucosa. Muscularis propria was not present within the webs. There was no evidence of inflammatory bowel disease, malignancy, or pathologic inflammation of the bowel or mesentery.