Abdomen : Case 9
History : A 30-year-old female with weight loss and constipation
Which abnormality is not seen in this film?
A. Large bowel dilatation
B. Small bowel dilatation
C. Stomach dilatation
D. Fecal impaction
Answer : C. Stomach dilatation is not seen in this film
Next question :
1. Is this bowel obstruction?
2. Partial or complete obstruction?
3. Site of obstruction?
4. Cause of this obstruction?
Additional plain film abdomen : upright
Air fluid levels with different height in the same loop of in dilated large bowel and small bowel.
Radiological finding :
- Colonic dilatation and fecal impaction at left side colon to the level of sigmoid colon
- Abrupt change of the colonic lumen at rectum
- Associated small bowel dilatation
Answer 1 : Large bowel obstruction
Answer 2 : Partial obstruction, because can see air in the rectum
Answer 3 : Site of obstruction : Rectum
Answer 4 : Cause of obstruction ?
Gut obstruction :
- Loops proximal to an obstruction will be dilated
- Loops distal to an obstruction will be decompressed or airless
Mechanical Large Bowel Obstruction:
Key Feature
- Dilated colon to point of obstruction
- Little or no air distal to the obstructive point
- Associated small bowel dilatation can be found
Mechanical Large Bowel Obstruction:
Causes :
- Tumor
- Volvulus
- Hernia
- Diverticulitis
- Intussusception
Abdominal CT images
CT finding : Circumferential rectal wall thickening-> Tissue diagnosis -> Rectal cancer
CT finding correlated with plain abdominal radiograph