m4 m8


1. What is abnormal? There is a dilated loop of some type in the left upper quadrant of the abdomen-the size is consistent with colon, since small bowel cannot generally reach this size without perforating. It does not make sense for this to be a dilated hepatic flexure because none of the more proximal colon is dilated. There are several loops of dilated small bowel, which suggests a more proximal colonic obstruction

2. How acute is the finding likely to be? Given the history, this is not likely acute but the size of this colonic loop and the lack of any other identifiable colon should raise concern for a longstanding obstruction, which can lead to ischemia and perforation.

3. What would you do next? This patient needs a CT, which confirmed the diagnosis of cecal volvulus. The cecum was ischemic and required extensive resection.

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small bowel

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