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Case 90: Laparoscopic treatment of Small Bowel Obstruction

A 51 year old man presented with symptoms and signs of a proximal small bowel obstruction. He had a right paramedian scar from an urgent cholecystectomy that was performed 20 years ago.

Image provided by: Mr Patrick Moore - General and Bariatric Surgeon.

1. What has caused the obstruction?

2. What are the features that would enable you to say that the obstruction was proximal preoperatively?