QuestionSBA
QuestionChoice
The x-ray shows large bowel obstruction, as the dilated bowel loops are peripheral and show haustra (rather than the valvulae conniventes seen in small bowel obstruction). Adhesions usually cause small bowel obstruction, not large bowel obstruction.
10034868
b
Adhesional bowel obstruction
QuestionChoice
The x-ray appearances are in keeping with large bowel obstruction, which is commonly caused by colorectal carcinoma. Mesenteric ischaemia would present more acutely, with severe pain and without these x-ray findings. The serum lactate may be raised.
10034871
e
Mesenteric ischaemia
QuestionChoice
Pseudo-obstruction is a differential, however, it is a rare diagnosis and one that can only be made when cross-sectional imaging fails to demonstrate a mechanical obstruction. It is more likely that this patient has a mechanical large bowel obstruction, caused by an underlying carcinoma.
10034870
d
Pseudo-obstruction (Ogilve's Syndrome)
QuestionChoice
The history, examination findings, and x-ray appearance of dilated peripheral bowel loops are in keeping with large bowel obstruction. The most common cause of large bowel obstruction (especially in this demographic) is an obstructing tumour. Hypernatraemia is due to dehydration due to poor oral intake.
10034867
a
Colorectal carcinoma
QuestionChoice
The appearance of the x-ray and the clinical presentation is suggestive of large bowel obstruction, likely secondary to a tumour. Inflammatory bowel disease can cause toxic megacolon (which has a different appearance), or classically small bowel obstruction (e.g. in Crohn's). The history does not mention a chronic course of events.
10034869
c
Inflammatory bowel disease
QuestionComment
where are the haustra???
43593
QuestionComment
Thats Coffee bean sign on abdo xray, sigmoid vulvulus causing obstruction likely due to cancer.
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Power Jargon
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Ale
Concept
Chapter
2693
6097
Large bowel obstruction
Topic
135
General surgery
19377
Colorectal carcinoma is a common cause of large bowel obstruction in elderly patients presenting with progressive constipation and abdominal distension.
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Topic
135
General surgery
A 77-year-old man has had severe progressive constipation for the past week and has started vomiting today. His GP referred him to the emergency department as he was in significant discomfort.

On examination, he has a tense, distended, uncomfortable abdomen. There are no signs of peritonism. His rectum is empty on PR examination, with no masses or faeces noted.

Observations are stable. Blood tests show hypernatraemia and a raised CRP.

An abdominal x-ray is performed:

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What is the most likely underlying diagnosis?
a