School ager post appendectomy 3 months ago, now with abdominal pain and vomiting AXR supine (left) shows multiple dilated loops of small bowel and a paucity of gas in the colon. Image from an upper GI and small bowel follow through exam the next day (right) shows interval increasing dilation of the loops of small bowel. Contrast never reached the colon. The diagnosis was distal small bowel obstruction due to adhesions.