Small bowel obstructionWhat is the diagnosis?

• Multiple dilated, centrally located small bowel loops
• Numerous air–fluid levels at different heights on the erect film
• CT shows dilated, fluid-filled small bowel loops with air–fluid levels

Dilated small bowel with multiple air–fluid levels in a patient with previous surgery suggests adhesional small bowel obstruction.

CT confirms the diagnosis, finds the transition point and — most importantly — looks for strangulation: reduced wall enhancement, mesenteric oedema, free fluid or a closed loop. Those features mean surgery; otherwise most adhesional obstructions settle with decompression and fluids.