Case of the Month March 2015, Page 2

Answer 1

B: Abdominal plain film

For a full-size image, please click on Mrs. J. H. 1 .

The image demonstrates marked distension of a loop of large bowel with its long axis extending from the right lower quadrant to the epigastrium or left upper quadrant.  Note how the colonic haustral pattern is maintained (Gaillard, et al. Radiopedia article on Caecal volvulus. http://radiopaedia.org/articles/caecal-volvulus).

Per ACR guidelines, the initial imaging study for a patient presenting with abdominal pain and distention is an abdominal x-ray (http://www.acr.org/~/media/79a594819bbd4631a7e31404daa66ef6.pdf).

Question 2

At this point, what would be the leading diagnosis?


A) Distal small bowel obstruction
B) Normal variant
C) Cecal volvulus
D) Sigmoid volvulus
E) Intussusception

 

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