An 83-year-old woman in a nursing home presents with a 24-hour history of obstipation and distended abdomen her vital sign and laboratory tests are normal plain abdominal film reveals a massively dilated loop of bowel in the lower abdomen. Most likely diagnosis for this patient?
A. Small bowel obstruction
B. Fecal impaction
C. Cecal volvulus
D. Sigmoid volvulus
A. Small bowel obstruction
B. Fecal impaction
C. Cecal volvulus
D. Sigmoid volvulus
Ans.
D. Sigmoid volvulus
Sigmoid volvulus is most common in
elderly and institutionalized individuals and usually presents with acute
obstruction, abdominal distention, and obstipation, Plain films reveal a
U-shaped, dilated loop of bowel in the lower abdomen. Ogilvie syndrome, or
colonic pseudo-obstruction, usually involves the entire large bowel. Small
bowel obstruction would appear as “Stair stepping” of loops of small bowel on
plain film examination. Cecal volvulus appears as a bean-shaped loop of bowel
in the left upper quadrant LUQ. of the
abdomen.
