Unusual Presentation of Small Bowel Obstruction

A 43-year-old previously healthy retired soldier from Horowpothana in Sri Lanka presented initially with left loin-to-groin pain suggestive of left ureteric colic. He first sought traditional treatment from a local exorcist, after which his abdominal pain worsened, prompting admission to a local hospital where symptoms were temporarily relieved with medication.  Laboratory investigations, including serum electrolytes and amylase, were normal. Plain abdominal X-ray showed dilated small bowel loops, and CECT abdomen demonstrated dilated small bowel loops with a transition point at the distal ileum, consistent with a diagnosis of mechanical small bowel obstruction.
This case highlights the importance of early medical evaluation in acute abdominal pain and the potential risks of delayed presentation due to initial reliance on traditional or non-medical interventions. A seemingly benign presentation such as ureteric colic may mask or evolve into a surgical abdominal emergency like small bowel obstruction. Careful clinical reassessment, early imaging (especially CECT), and timely referral are crucial to identify a transition point and prevent complications such as bowel ischemia or perforation.