Small bowel obstruction in a young adult
- Department of Surgery, Daisy Hill Hospital, Newry, Northern Ireland
- Mr DW Harkin, Specialist Registrar General Surgery, 37 Wynchurch Terrace, Rosetta, Belfast BT6 OHP, Northern Ireland
- Accepted 21 July 1998
A 21-year-old man presented to hospital with a 3-day history of increasing vomiting, abdominal pain and distension, and constipation. On questioning, he gave a 3-month history of poor appetite, intermittent abdominal cramps, intermittent diarrhoea and weight loss of approximately 13 kg. He had no relevant medical or family history, and had no previous surgery. He was apyrexic clinically anaemic, with a centrally distended abdomen, but no abdominal scars or external hernia. Bowel sounds were obstructive but there were no obvious signs of peritonism. Positive blood results showed a microcytic hypochromic anaemia (haemoglobin 7.9 g/dl) and a low serum albumin (corrected albumin 26 g/l), his inflammatory markers were also grossly elevated (C-reactive protein (CRP) 112 IU/l; erythrocyte sedimentation rate 77). Erect and supine abdominal X-rays are shown in figures 1 and2.
Erect abdominal X-ray
Supine abdominal X-ray
Questions
- 1
- What do the abdominal X-rays show (figures 1 and 2)?
- 2
- What is the differential diagnosis?
- 3
- What is the most appropriate treatment?
Answers
QUESTION 1
The erect abdominal X-ray (figure 1) shows a large air-filled viscus in the upper abdomen with two long fluid levels. The supine abdominal X-ray (figure 2) shows several grossly dilated small bowel loops in the central upper abdomen. No obvious free intra-peritoneal gas is seen outlining the ligamentum teres, major viscus, paracolic gutters, or between adjacent bowel loops (Riggler's sign) on either X-ray. An erect chest film also showed no subdiapragmatic air.
QUESTION 2
The differential diagnosis is small bowel obstruction (adhesions, …
