31-year-old male, postoperative day 4 following exploratory laparotomy with adhesiolysis, with persistent ileus and absence of flatus. CT abdomen/pelvis with contrast to evaluate for mechanical small bowel obstruction or other postoperative complication.

None available.

Axial CT images of the abdomen and pelvis were obtained following intravenous administration of 100 mL Omnipaque 350 and oral contrast. Multiplanar reformations were generated.

Trace bibasilar atelectasis. No effusion or consolidation.

Normal in size and attenuation. No focal lesion.

Unremarkable.

Normal.

Normal.

Bilaterally unremarkable.

A 3.4 cm enhancing solid mass arises from the lower pole of the left kidney (images 88-94, series 3). The lesion demonstrates heterogeneous enhancement with attenuation values of approximately 75 HU on the post-contrast acquisition, increased from background renal parenchyma. No perinephric extension identified. No regional lymphadenopathy. No renal vein involvement. The right kidney and remainder of the left kidney are otherwise unremarkable. No hydronephrosis.

Diffuse dilation of small bowel loops up to 3.8 cm in caliber without a discrete transition point, compatible with postoperative ileus. No closed-loop obstruction. No bowel wall thickening, pneumatosis, or free intraperitoneal air. Trace free fluid in the pelvis, likely postoperative.

Patent. No filling defect.

Bladder is unremarkable.

Unremarkable.

Expected postsurgical changes along the midline laparotomy incision without fluid collection.

1. Findings compatible with postoperative ileus. No mechanical small bowel obstruction identified. No closed-loop obstruction or ischemia. 2. 3.4 cm enhancing solid left renal mass, highly suspicious for renal cell carcinoma. Recommend urology consultation and dedicated renal mass protocol CT or MRI for full characterization and staging. 3. Trace pelvic free fluid, expected postoperative.