Figure 2. A 95-year-old man presented with small bowel obstruction (SBO) and diffuse abdominal tenderness. (a) Contrast enhanced CT at the mid abdomen shows a cluster of dilated, unopacified, fluid-filled small bowel loops (thin black arrows) with converging mesenteric vessles (black arrow), in the left abdomen adjacent to the left abdominal wall with no overlying omental fat, displacing the transverse colon posteriorly (white arrowheads) and medially. The dilated loops show mural thickening with relative hypoperfusion with adjacent mesenteric fluid suggesting strangulation. (b) More caudally, the conglomerate of dilated small bowel loops with a thickened wall, some with the small bowel faeces sign (black arrows), are seen displacing the proximal transverse colon (arrowhead). Blurred and engorged mesenteric vessels are seen, converging toward the orifice of the hernia sac (white arrows) as well as free peritoneal fluid. A pre-operative CT diagnosis of an incarcerated, strangulated transmesenteric internal hernia was confirmed on surgery.