Small Bowel Obstruction Due to a Primary Ileo-mesenteric Adhesion in an Elderly Patient with no Prior Surgery: A Case Report and Literature Review

Abstract

Background: Primary adhesive bands are thought to arise from aberrant embryological peritoneal attachments or de novo fibrous formations and can lead to luminal obstruction, vascular compromise, or closed-loop obstruction if they entrap bowel segments. Case Report: A 72-year-old man with type 2 diabetes and hypertension, but no surgical history, presented with four days of abdominal distension and obstipation. Examination revealed a tympanitic, distended abdomen; laboratory results were notable for mild leukocytosis and an episode of diabetic ketoacidosis. Computed Tomography (CT) imaging demonstrated dilated ileal loops with air–fluid levels, a transition point with a “beak sign,” distal ileal wall thickening, adjacent mesenteric fat infiltration, multiple small mesenteric lymph nodes, and collapsed distal bowel loops. No pneumatosis or free air was observed. A midline laparotomy revealed a retro-umbilical ileo-epiploic adhesion causing small bowel strangulation. Adhesiolysis restored bowel viability, and the patient recovered uneventfully, being discharged on postoperative day 4. Discussion: Primary adhesive bands are a rare cause of Small bowel obstruction (SBO) in a virgin abdomen, posing diagnostic challenges as preoperative imaging rarely identifies the band itself. CT imaging is crucial for assessing obstruction, closed-loop configuration, and bowel viability. Management depends on obstruction severity and viability: non-operative approaches may succeed in partial obstruction, whereas complete or closed-loop obstructions require urgent surgical intervention. Definitive treatment involves adhesiolysis, with segmental bowel resection reserved for non-viable segments. Laparoscopic approaches are increasingly feasible, offering reduced morbidity in selected patients. Conclusion: Although uncommon, primary ileo-mesenteric adhesions should be considered in elderly patients presenting with SBO without prior abdominal surgery. Early recognition, prompt imaging, and timely surgical intervention are critical to prevent ischemic complications and ensure favorable outcomes.