A 45-year-old male with a history of significant prior blunt trauma to the abdomen, presents 5 monts after the traumatic event with abdominal pain and nausea

CT Reconstruction in the Coronal  plane shows

A) Partial SBO probably caused by adhesions
B) Partial SBO probably caused by splenosis
C) Complete SBO probably caused by adhesions
D) Partial SBO probably caused by omental malignancy

1. Findings

Splenosis with Small Bowel Obstruction
A 45-year-old male with a history of significant prior blunt trauma to the abdomen, presents with abdominal pain and nausea. CT of the abdomen (coronal view) shows dilated small bowel loops with decompression of visualised large bowel,  consistent with small bowel obstruction.  In addition there are  multiple scattered soft tissue nodules throughout the peritoneal cavity, which in this clinical context raises the possibility of  splenosis and likely the cause of the SBO.
Comment:
The presence of multiple soft tissue nodules in the peritoneal cavity, consistent with splenosis, results from splenic tissue seeding following trauma or splenectomy. These nodules are often functional and can mimic peritoneal carcinomatosis but should be differentiated based on imaging and clinical history. Tc-99m sulfur colloid scans can confirm the presence of splenic tissue. Bowel obstruction in this case is likely secondary to splenosis and possibly adhesions as well from prior trauma.   An image below shows direct involvement of splenosis on the the SBO
Ashley Davidoff MD TheCommonVein.net (42226.1) 002SB).

Correct answer B

Comment: The presence of multiple soft tissue nodules in the peritoneal cavity, (in the context of prior trauma and absent spleen) is consistent with splenosis, results from splenic tissue seeding following trauma or splenectomy. These nodules are often functional and can mimic peritoneal carcinomatosis but should be differentiated based on imaging and clinical history. Tc-99m sulfur colloid scans can confirm the presence of splenic tissue. Partial bowel obstruction in this case is likely secondaryBowel obstruction in this case is likely secondary to splenosis and possibly adhesions as well from prior trauma.   An image below shows direct involvement of splenosis on the the SBO

Why the Other Options Are Incorrect:

• A) Partial SBO probably caused by adhesions
  → While adhesions are a common cause of SBO in patients with prior trauma or surgery, they do not typically present as discrete peritoneal soft tissue nodules. The presence of multiple nodules with a specific pattern — in a patient with a known history of splenic trauma — favors splenosis over isolated adhesive disease. Thus, adhesions alone do not account for the full imaging picture.
• C) Complete SBO probably caused by adhesions
  → Although the distal colon appears decompressed, oral contrast is present in the descending colon, confirming that this is a partial, not complete, obstruction. Additionally, as with A, the presence of peritoneal nodules argues against simple adhesions and supports splenosis as a contributing factor.
• D) Partial SBO probably caused by omental malignancy
  → Peritoneal or omental malignancy (e.g., carcinomatosis) is part of the differential for multiple peritoneal nodules, but the clinical history of trauma, absent spleen, and nodular distribution are far more characteristic of splenosis. There is also no known primary malignancy, no signs of metastatic disease elsewhere, and the nodules are well-circumscribed, favoring a benign etiology.
• • Computed tomography (CT) scans play a crucial role in diagnosing both splenosis and small bowel obstruction (SBO).

Splenosis is the autotransplantation of splenic tissue into abnormal locations following trauma or splenectomy. CT imaging is instrumental in identifying splenic implants, which can mimic neoplasms. The imaging features of splenosis are identical to those of native splenic tissue, making CT scans highly effective in differentiating splenosis from other pathologic entities, thus avoiding unnecessary invasive procedures. CT scans can reveal the presence, number, and size of splenic implants, aiding in accurate diagnosis.[1-3]

Small bowel obstruction (SBO) The American College of Radiology (ACR) recommends CT scans for suspected SBO due to their high diagnostic accuracy, which exceeds 90%. CT imaging can identify the transition point, the level of obstruction, and the cause of the obstruction, such as adhesions, neoplasms, or, in rare cases, splenosis. Multidetector CT scanners with multiplanar reconstruction capabilities enhance the evaluation of SBO, providing detailed information that can guide management decisions.[4-5]

In summary, CT scans are essential for diagnosing splenosis and SBO, offering high accuracy and detailed imaging that can differentiate splenosis from malignancies and identify the cause and severity of SBO.