RADIOLOGY: GASTROINTESTINAL: GI: Case# 33078: INTERNAL HERNIA WITH SMALL BOWEL OBSTRUCTION. 59 year old male with adenocarcinoma of unknown primary origin who has a known met in the L3 vertebral body. 1. Multiple low attenuation liver lesions are now noted, which were not seen on the prior scan and most likely represent metastatic disease. 2. Lytic lesion within the L3 vertebral body is consistent with the metastatic process, and now there are other lytic lesions noted within the lumbar spine as well as the left sacral ala and left superior pubic ramus consistent with progressing metastatic disease. 3. Dilated loops of fluid-filled small bowel are seen with transition point on image #40 consistent with a small bowel obstruction. 4. Fullness of retroperitoneal soft tissues at the L3 level where radiation treatment was received, most likely due to prior treatment with radiation. 5. No change in soft tissue thickening of the cecum since the prior exam which could represent site for colon cancer. Air contrast barium enema could be helpful if clinically indicated. 6. Soft tissue thickening noted in transverse colon is not seen on the prior scan and may represent peristalsis; however, tumor could not be excluded. 7. No change in soft tissue thickening of rectum. 8. Bilateral lower lobe streaky air space opacities are noted which represent atelectasis and/or infiltrate. Recommend clinical correlation. 9. Heterotopic bone noted above the right superior pubic ramus may represent old trauma. Plain radiographs of this area may be helpful to further differentiate etiology.