Question
A patient presents to the emergency department with pain and distension of abdomen and absolute constipation. What is the investigation of choice?
The correct answer is
Plain X-ray abdomen (Erect)
Investigating Abdominal Pain, Distension, and Constipation
The patient's symptoms—abdominal pain, distension, and absolute constipation—are classic indicators of a potential bowel obstruction.
Choosing the Right Investigation
The primary goal is to confirm the obstruction and potentially identify its location and cause quickly.
- Plain X-ray abdomen (Erect) is the investigation of choice in this acute scenario.
Rationale for Choice
An erect abdominal X-ray is preferred because:
- It can effectively demonstrate signs of obstruction, such as dilated loops of bowel and characteristic air-fluid levels. The erect position helps distinguish between gas and fluid.
- It is a rapid, accessible, and relatively low-risk initial diagnostic tool.
- It helps differentiate between small bowel obstruction (SBO) and large bowel obstruction (LBO).
Evaluating Other Options
Other investigations are less suitable as the *initial* choice:
- Ultrasonography: May show dilated bowel but is less sensitive and specific for confirming obstruction compared to X-ray or CT, especially for determining the exact level.
- Barium meal follow-through: Generally contraindicated in suspected acute obstruction. Barium contrast can worsen the blockage and complicate surgical management if needed.
- Colonoscopy: Primarily examines the colon. It is not suitable for diagnosing obstruction in the small bowel, which is a common cause of these symptoms. It is also invasive and not the first step for acute presentation.
Therefore, the plain erect abdominal X-ray provides the most appropriate and immediate diagnostic information for suspected bowel obstruction.
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Important Questions from Intestines
- A 22-year female has presented with a history of malaise, cough, alternating constipation and diarrhoea with intermittent abdominal pain for last 6 months. She also complains of abdominal distension for last 2 days. On examination her abdomen has a doughy feel along with an ill defined mass over the right lower quadrant. She is most likely suffering from:
- Gentleman of 56 years underwent laparoscopic left hemicolectomy for diagnosed left colonic carcinoma. Histopathology revealed the tumour to be invading submucosa and muscularis propria. Among the 16 regional lymph nodes harvested, 2 were positive for malignant deposits.
His staging as per AJCC will be: - A 40 year old female patient presents with colicky abdominal pain associated with episodes of mild diarrhoea for last 6 months accompanied with intermittent fever and weight loss. There are multiple discharging sinuses on perineal examination. The most likely clinical diagnosis in this patient is:
- An eight month old male child is brought to the emergency with recurrent episodes of screaming and drawing up of legs. The child appears to be listless in between the attacks. Local examination of abdomen reveals feeling of emptiness in the right iliac fossa and blood stained mucus is found on the finger on per rectal examination. The most probable clinical diagnosis in this child is
- Which of the following statements regarding Ogilvie's syndrome are correct?
1. It presents as acute large bowel mechanical obstruction
2. Marked caecal dilatation is a common feature on X-ray abdo- men
3. Caecal perforation is a well recog- nized complication of this condi- tion
4. Intravenous Neostigmine is used for the treatment of this condition
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