Case of the week 4

This week's case is a non-contrast CT of the abdomen and pelvis in a 69 year old man with abdominal pain. He had a recent renal transplant in the left lower quadrant related to chronic renal disease and could not receive intravenous contrast.

Four images are provided, axial at the level of the kidneys (top left), axial lower in the abdomen (top right), coronal (bottom left), and sagittal (bottom right).

The radiologist interpreting this study concluded that the abdominal pain was related to small bowel obstruction, likely secondary to adhesions.

Are there any relevant findings in the images provided?

What would be your diagnosis?

What would be your recommendation?

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