History of gastric bypass presenting with abdominal pain. Evaluate for bowel obstruction. Per EPIC note patient had a Roux-en-Y gastric bypass. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Several small bowel loops are poorly distended. There are several jejunal bowel loops which are significantly dilated up to 4.9 cm (series 701/20) in the left upper quadrant with a suspected high-grade transition point in the lower mid-abdomen (series 701/13). There are additional dilated bowel loops in the epigastric region (series 501/8). No discrete mass is seen at the transition point. Of note, the duodenojejunal junction does not appear to cross the midline, this may be sequela from prior surgery or due to an internal hernia. Contrast has progressed distally to the proximal colon. The sigmoid colon is tortuous and redundant with the transverse colon collapsed in the mid-abdomen. No significant interloop loop fluid, differential bowel enhancement or bowel wall thickening. No significant free fluid or loculated fluid collection. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: See discussion above. There is a small volume free fluid in the pelvis, unchanged.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
Dilated proximal mid small bowel with a high-grade transition point in the mid abdomen suspicious for a small bowel obstruction. The findings suggest that this may be due to adhesive disease or an internal hernia. No specific findings of bowel compromise. These findings were discussed with the ordering physician (Dr. Alverdy) at 1645 on 05/17/2016.