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Case of the Week 465


What is the most likely diagnosis?

  • 71 year-old bedridden male with abdominal pain


Cine of Coronal Reconstruction of CT of Abdomen-Anterior to Posterior

  1. Small Bowel Obstruction
  2. Large Bowel Obstruction
  3. Colonic Pseudo-obstruction
  4. Sigmoid Volvulus
  5. Mesenteric Ischemia

Additional Image - Abdominal Radiographs

 

Additional Images

 

Supine and upright abdominal radiographs of same patient


Answer:

 

3. Colonic Pseudo-obstruction

 

More (Click Discussion Tab)

 

 

Colonic Pseudo-obstruction

General Considerations

  • Mimics large bowel obstruction without point of obstruction
  • Mostly in those over 60, with a slight male predominance
  • Apparently due to autonomic nervous system imbalance leading to a dysfunctional distal colon and colonic ileus similar to Hirschsprung’s disease
  • The cecum, having the largest resting diameter to start, is the most easily dilated (Laplace law)
  • Can lead to ischemic of bowel and perforation

 

MORE . . .

 


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