Internal mesenteric hernia causing closed loop sbo

High grade small bowel obstruction with apparent transition point at the level of proximal ileal loops demonstrating Whirlpool like twisting of mesenteric vessels in right lumbar quadrant – likely related to internal mesenteric hernia or volvulus.

A large dilated small bowel loop in left upper quadrant, likely related to closed loop obstruction demonstrating air fluid level with tiny intramural loculi suggesting early gangreneous changes

SMA, SMV demonstrates normal relationship with normal position of duodeno jejunal junction to the left

Small free fluid in pelvis

Tiny sludge like gall bladder calculi

No evidence of pneumoperitoneum