Can you find the underlying pathology (the cause of acute abdomen)?
Signs of ileus are present. Tubular structure in the ileocecal region is found, with thickened wall and slightly blurred surrounding fat tissue. Differential includes acute appendicitis, acute diverticulitis and obstruction due to fibrous adhesions. Due to patient's history, the latter is most probable, and, on closer inspection, zone of transition between normally calibrated and distended bowel can be seen. The tubular structure is, in fact, obstructed ileum!
Which congenital anomaly is seen in this patient?
Ectopic subdiaphragmal kidneys.
Signs of ileus are present: small bowel is dilated with gas-fluid levels. The underlying cause can be identified, as transitional zone is seen in the terminal ileum, which shows thickened wall and blurred surrounding fat tissue. Most likely, postoperative fibrous adhesions have caused small bowel obstruction. Free fluid is seen in the pelvis. Note the intestinal malrotation, with colon predominately within the left hemiabdomen.
Ectopic kidneys can be seen: left between spleen and diaphragm, and right between liver and diaphragm.