History :  A 50-year-old man with abdominal distension.

What is the abnormality?

A. Large bowel dilatation
B. Small bowel dilatation

C. Small and large bowel dilatation

D. Free air
 

Answer : C .Small and large bowel dilatation

• This film shows abdominal suture clips on the skin, corresponding with S/P abdominal surgery
• Small and large bowel dilatation in this case, due to post operative ileus

Ileus :

• Ileus is a term used for aperistaltic bowel not caused by a mechanical obstruction
• Appearances are similar to those of mechanical obstruction
• Multiple loops of gas filled bowel projected centrally over the abdomen

Aetiology :

• Drugs: e.g. opioids
• Metabolic: e.g. hyponatremia
• Sepsis: especially gram-negative bacteria
• Abdominal trauma or surgery (see below)
• Myocardial infarction / congestive heart failure
• Head injury or neurosurgery
• Intra-abdominal inflammation and peritonitis
• Retroperitoneal hematoma

Post operative ileus:

• Appearances are similar to those of mechanical obstruction
• There are multiple loops of gas filled bowel projected centrally over the abdomen
• This patient had prolonged non-colicky abdominal pain following a abdominal surgery recovery was spontaneous