Woman 88yo suddenly got epigastric pain and vomitting. Ultrasound abdomen first nothing abnormal detected. After 10 hours, ultrasound in second time shows small intestine dilated and hyperperistalsis, colon no dilated (see 2 pictures of small bowel dilated) but cannot make sure why small bowel in obstruction.
Chest X-ray revealed air-water level at right subdiaphagmatic, so suspected a subdiapragmatic abcess.
But MSCT detected small intestin moving over the liver and fixed to right diaphragm and in strangulation (see CT pictures).
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Summary: Ultrasound, X-ray, CT cannot make sure why small bowel in obstruction, but surgery in emergency is done.
Emergency operation detected small bowel fixed onto falciform ligamentum by one orifice of 2 cm diameter. It is an internal hernia due to defected falciform ligamentum. See picture of orifice of falciform ligamentum.
